Individual
MS. JACKIE DOWNIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
219 EAST PINE STREET, SUITE 104, PINEDALE, WY 82941-0484
(307) 367-4118
Mailing address
PO BOX 484, PINEDALE, WY 82941-0484
(307) 367-4118
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
L2425
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11888060
CAQH
OR
Enumeration date
10/05/2006
Last updated
01/14/2019
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