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Individual

MR. HOLLI VERN JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MSW

Contact information

Practice address
829 CHIEF EDDIE HOFFMAN HWY, BETHEL, AK 99559
(907) 543-6100
(907) 543-6159
Mailing address
PO BOX 528, BETHEL, AK 99559-0528
(907) 546-6100
(907) 543-6159

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
27403
CA
1041C0700X
Clinical Social Worker
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1020986
AK
Enumeration date
09/10/2013
Last updated
11/20/2019
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