Individual
MR. BRENT L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
1031 W SANETTA ST, NAMPA, ID 83651-5047
(208) 466-7443
(208) 466-5058
Mailing address
1031 W SANETTA ST, NAMPA, ID 83651-5047
(208) 466-7443
(208) 466-5058
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
31373
ID
Other
Enumeration date
04/22/2013
Last updated
04/22/2013
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