Individual
MS. DANIELLE MARIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
8503 75TH ST, SUITE A, KENOSHA, WI 53142-7620
(262) 654-9370
Mailing address
2224 34TH AVE, KENOSHA, WI 53144-1439
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
3402226
WI
101YP2500X
Professional Counselor
Primary
7473-125
WI
Other
Enumeration date
01/25/2017
Last updated
08/28/2019
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