Individual
KEISHA G JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
4411 WASHINGTON AVE STE 300, EVANSVILLE, IN 47714-0900
(812) 479-1916
Mailing address
4411 WASHINGTON AVE STE 300, EVANSVILLE, IN 47714-0900
(812) 479-1916
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
99086417A
IN
Other
Enumeration date
06/13/2018
Last updated
06/13/2018
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