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Individual
MR. JERRY MICHAEL JACKSON
Active
Individual
MR. JERRY MICHAEL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, ACSW
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LW00004286
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LW00004286
LICENSED SOCIAL WORKER
WA
Enumeration date
08/31/2006
Last updated
07/08/2007
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