Individual
JANET E. JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., SLPC
Contact information
Practice address
321 N. HULL ST., 'OLD ALABAMA TOWN', MONTGOMERY, AL 36104
(334) 262-1434
(334) 262-1435
Mailing address
321 N. HULL ST., 'OLD ALABAMA TOWN', MONTGOMERY, AL 36104
(334) 269-4156
(334) 269-4157
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
1661
AL
101YM0800X
Mental Health Counselor
Primary
#1661/SLPC#448
AL
101YM0800X
Mental Health Counselor
#1661;#448
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051512316
BLUE CROSS
AL
01
—
515-09617
BLUE CROSS FED'L
—
Enumeration date
10/04/2005
Last updated
03/21/2012
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