Individual
JENNIFER LYNNE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4730 BECKNER ROAD, SANTA FE, NM 87507
(055) 989-4500
Mailing address
4730 BECKNER ROAD, SANTA FE, NM 87507-4619
(505) 989-4500
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
M-10624
NM
1041C0700X
Clinical Social Worker
Primary
C-11724
NM
Other
Enumeration date
02/11/2015
Last updated
10/02/2023
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