Individual
ANGELA L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
404 W GREEN ST, URBANA, IL 61801-3267
(217) 706-5498
Mailing address
404 W GREEN ST, URBANA, IL 61801-3267
(217) 398-9066
(217) 398-9077
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149013402
IL
Other
Enumeration date
11/23/2011
Last updated
03/15/2021
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