Individual
KEVIANA Y JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LMSW
Contact information
Practice address
3401 BERRYWOOD DR STE 203, COLUMBIA, MO 65201-6515
(573) 777-2455
Mailing address
2885 W BATTLEFIELD ST, SPRINGFIELD, MO 65807-3952
(417) 849-7731
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2022001657
MO
Other
Enumeration date
01/10/2024
Last updated
07/01/2025
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