Individual
JESSICA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
906 E CHESTNUT ST, BLOOMINGTON, IL 61701-3308
(309) 445-3696
Mailing address
906 E CHESTNUT ST, BLOOMINGTON, IL 61701-3308
(309) 750-6496
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
178.011232
IL
101YP2500X
Professional Counselor
Primary
180.014961
IL
Other
Enumeration date
04/12/2021
Last updated
01/03/2023
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