Individual
MR. SHAWN A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SAC-IT
Contact information
Practice address
10532 N. PORT WASHINGTON RD., MEQUON, WI 53092
(262) 242-3810
(262) 242-3816
Mailing address
10532 N PORT WASHINGTON RD, MEQUON, WI 53092-5563
(262) 242-3810
(262) 242-3816
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
16299-130
WI
Other
Enumeration date
12/13/2011
Last updated
01/11/2013
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