Individual
MRS. AUTUMN KAMINEH BADGER JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1900 E MAIN ST, DANVILLE, IL 61832-5100
(217) 554-4074
Mailing address
1900 E MAIN ST, DANVILLE, IL 61832-5100
(217) 554-4074
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
150111308
IL
Other
Enumeration date
05/15/2024
Last updated
05/15/2024
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