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Individual
MATTHEW JACKSON
Active
Individual
MATTHEW JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
6801101413
MI
104100000X
Social Worker
Primary
6801117121
MI
1041C0700X
Clinical Social Worker
6801117121
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6801117121
LARA
MI
Enumeration date
07/17/2019
Last updated
09/29/2025
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