Individual
JACQUELYN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3040 TEDDY DRIVE, BATON ROUGE, LA 70809
(225) 218-4444
Mailing address
3040 TEDDY DRIVE, BATON ROUGE, LA 70809
(225) 218-4444
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
106S00000X
Behavior Technician
—
LA
171M00000X
Case Manager/Care Coordinator
—
LA
Other
Enumeration date
04/20/2017
Last updated
06/30/2021
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