Individual
MRS. DONNA MARIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LSW, CDP
Contact information
Practice address
4212 OLD GRAND AVE, SUITE 102, GURNEE, IL 60031-2708
(847) 336-5621
(847) 336-2594
Mailing address
860 BREEZE DR, LAKE VILLA, IL 60046-6692
(847) 553-1259
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
150-006550
IL
Other
Enumeration date
02/10/2017
Last updated
02/10/2017
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