Individual
VERONDA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3774 N 13TH ST, MILWAUKEE, WI 53206-3011
(414) 792-0775
Mailing address
3774 N 13TH ST, MILWAUKEE, WI 53206-3011
(414) 792-0775
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
17739-130
WI
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/23/2022
Last updated
03/23/2022
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