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Individual
KYLIAH LANEICE JACKSON
Active
Individual
KYLIAH LANEICE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW-CP
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
17505
SC
101YM0800X
Mental Health Counselor
29403
MN
1041C0700X
Clinical Social Worker
17505
SC
1041C0700X
Clinical Social Worker
Primary
29403
MN
106S00000X
Behavior Technician
—
NULL
Other
Enumeration date
05/08/2018
Last updated
02/24/2025
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