Individual
DAVID JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
220 RAILROAD ST SE, PINE CITY, MN 55063-1540
(320) 629-7600
Mailing address
220 RAILROAD ST SE, PINE CITY, MN 55063-1540
(320) 629-7600
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
21551
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21551
—
MN
Enumeration date
12/22/2022
Last updated
12/22/2022
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