Individual
DANITA A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC-IT
Contact information
Practice address
10045 W LISBON AVE, WAUWATOSA, WI 53222-2446
(414) 358-7999
(414) 358-7158
Mailing address
10045 W LISBON AVE, WAUWATOSA, WI 53222-2446
(414) 358-7999
(414) 358-7158
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1854-226
WI
Other
Enumeration date
08/20/2013
Last updated
03/22/2014
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