Individual
MRS. PATRICIA L JACKSON-ISTAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSCSW, LCAC
Contact information
Practice address
210 W 21ST ST, CONCORDIA, KS 66901-5200
(785) 243-8900
(785) 243-8933
Mailing address
415 TIMBERWICK PL, MANHATTAN, KS 66503-3054
(785) 313-0900
(785) 537-8028
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
468
KS
1041C0700X
Clinical Social Worker
Primary
3587
KS
Other
Enumeration date
06/16/2006
Last updated
04/04/2018
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