Individual
MR. NYLES ANTONY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, APSW, SAC-IT
Contact information
Practice address
4109 67TH ST, KENOSHA, WI 53142-3836
(262) 652-9830
(262) 652-2931
Mailing address
4109 67TH ST, KENOSHA, WI 53142-3836
(262) 652-9830
(262) 652-2931
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
15877-130
WI
104100000X
Social Worker
Primary
128033-121
WI
Other
Enumeration date
04/07/2010
Last updated
04/07/2010
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