Individual
MS. MICHELLE RENE' JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
24728 FALCON RD, LEBANON, MO 65536-6137
(417) 622-8472
(417) 588-4296
Mailing address
24728 FALCON ROAD, LEBANON, MO 65536-6137
(417) 622-8472
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2005018482
MO
Other
Enumeration date
08/10/2006
Last updated
07/23/2015
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