Individual
GARRICK D JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2545 N ELDORADO AVE, KLAMATH FALLS, OR 97601-6423
(541) 883-3471
(541) 883-3524
Mailing address
2545 N ELDORADO AVE, KLAMATH FALLS, OR 97601-6423
(541) 883-3471
(541) 883-3524
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
A2147
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
090450
—
OR
Enumeration date
06/02/2008
Last updated
02/16/2012
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