Individual
ALBERT JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AODA
Contact information
Practice address
4001 W CAPITOL DR, MILWAUKEE, WI 53216-2530
(414) 810-6691
Mailing address
4950 N 21ST STREET, MILWAUKEE, WI 53209-5750
(414) 301-1163
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
16862-130
WI
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
16862-130
WI
Other
Enumeration date
04/09/2013
Last updated
04/09/2013
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