Individual
ROGER DALE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
8200 GEORGIA ST, MERRILLVILLE, IN 46410-6227
(219) 791-1400
(219) 791-1422
Mailing address
3021 E 36TH AVE, LAKE STATION, IN 46405-2966
(219) 743-6579
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
12/12/2017
Last updated
10/11/2018
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