Individual
LISA JACKSON-ELDRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
501 S BURMA AVE, GILLETTE, WY 82716-3426
(307) 688-5029
Mailing address
PO BOX 3011, GILLETTE, WY 82717-3011
(307) 688-5029
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
830234097
—
WY
Enumeration date
07/22/2020
Last updated
07/22/2020
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