Individual
MR. MARKUS K JACKSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
105 E JEFFERSON BLVD, SUITE 700, SOUTH BEND, IN 46601-1922
(574) 232-2255
(574) 287-9377
Mailing address
105 E JEFFERSON BLVD, SUITE 700, SOUTH BEND, IN 46601-1922
(574) 232-2255
(574) 287-9377
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34004900A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000368745
ANTHEM
IN
01
—
PVPB106032
AMERICAN PSYCH SYSTEMS
IN
Enumeration date
10/13/2005
Last updated
07/08/2007
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