Individual
EDNA ELIZABETH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
1430 OLIVE ST STE 400, SAINT LOUIS, MO 63103-2303
(314) 206-3700
Mailing address
1430 OLIVE ST STE 400, SAINT LOUIS, MO 63103-2303
(314) 206-3700
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YP1600X
Pastoral Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
630
CRADC
MO
Enumeration date
04/29/2015
Last updated
07/28/2022
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