Individual
MICHELLE D JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
914 BAUMANN DR, GRAND ISLAND, NE 68803-4401
(308) 385-5250
(308) 385-5271
Mailing address
914 BAUMANN DR, GRAND ISLAND, NE 68803-4401
(308) 385-5250
(308) 385-5271
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
1164
NE
1041C0700X
Clinical Social Worker
Primary
657
NE
Other
Enumeration date
03/10/2015
Last updated
03/10/2015
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