Individual
MRS. KEGAN ELIZABETH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LGSW
Contact information
Practice address
205 CENTER ST, PRINCETON, WV 24740-2931
(304) 431-2424
Mailing address
156 REINDEER PL, PRINCETON, WV 24739-7156
(304) 888-5933
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
BP00945323
WV
Other
Enumeration date
09/17/2021
Last updated
09/17/2021
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