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Individual

DAMIEN JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
201 MAPLEWOOD AVE, MUNDELEIN, IL 60060-4129
(773) 234-4808
Mailing address
201 MAPLEWOOD AVE, MUNDELEIN, IL 60060-4129

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149021097
IL

Other

Enumeration date
02/10/2021
Last updated
02/10/2021
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