Individual
LISA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, MFT
Contact information
Practice address
815 FORWARD DR., MADISON, WI 53711
(608) 268-6530
(608) 709-1744
Mailing address
815 FORWARD DR., MADISON, WI 53711
(608) 268-6530
(608) 709-1744
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
249-228
WI
Other
Enumeration date
10/21/2011
Last updated
12/20/2021
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