Individual
WILLIAM JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSW
Contact information
Practice address
1001 W BROADWAY STE B, FARMINGTON, NM 87401-5638
(505) 326-2695
Mailing address
1001 W BROADWAY STE B, FARMINGTON, NM 87401-5638
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/01/2016
Last updated
01/13/2020
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