Individual
MS. GWENDOLYN SANDRA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.C.S.W.
Contact information
Practice address
2514 GATES CIR APT 12, BATON ROUGE, LA 70809-1017
(225) 205-1581
Mailing address
PO BOX 538, BAKER, LA 70704-0538
(225) 205-1581
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3189
LA
Other
Enumeration date
06/30/2011
Last updated
06/30/2011
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