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Individual

MISS KEIJUANNA JANEE JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LMSW

Contact information

Practice address
2928 W 5TH ST, FORT WORTH, TX 76107-2242
(817) 332-6348
Mailing address
2340 CAP ROCK LN, FORT WORTH, TX 76133-8906
(219) 789-1899

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
59218
TX

Other

Enumeration date
02/26/2018
Last updated
02/26/2018
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