Individual
BEATRICE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SUD COUNSELOR SAC
Contact information
Practice address
4800 S 10TH ST, MILWAUKEE, WI 53221-2412
(414) 744-5370
(414) 744-9052
Mailing address
4800 S 10TH ST, MILWAUKEE, WI 53221-2412
(414) 744-5370
(414) 744-4352
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15667-131
WI
Other
Enumeration date
09/19/2018
Last updated
09/19/2018
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