Individual
SPENCER JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PLMHP
Contact information
Practice address
8601 W DODGE RD STE 106, OMAHA, NE 68114-3405
(402) 575-5577
Mailing address
2009 S 56TH ST, OMAHA, NE 68106-2219
(712) 560-5835
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
13334
NE
Other
Enumeration date
05/09/2023
Last updated
05/09/2023
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