Individual
MRS. JACKLYN ELIZABETH ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, CADC, PLCSW
Contact information
Practice address
4355 PARIS GRAVEL RD, HANNIBAL, MO 63401-6017
(573) 248-3811
(573) 248-3080
Mailing address
900 E LAHARPE ST, KIRKSVILLE, MO 63501-4520
(660) 665-1962
(660) 665-3989
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2006021234
MO
Other
Enumeration date
10/16/2007
Last updated
11/05/2007
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