Individual
MARY ELLEN JACKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
401 STAGELINE RD, SUITE 7, HUDSON, WI 54016-7897
(715) 531-6760
(715) 531-6761
Mailing address
1196 QUINLAN AVE S, LAKELAND, MN 55043-9527
(651) 436-1606
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
617-124
WI
Other
Enumeration date
08/04/2006
Last updated
07/08/2007
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