Individual
MAREN RUTH L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2501 CAPEHART RD, OFFUTT AFB, NE 68113-1043
(402) 294-7790
Mailing address
2501 CAPEHART RD, OFFUTT AFB, NE 68113-1043
(402) 294-7790
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
09927421
CO
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
09927421
CO
1041C0700X
Clinical Social Worker
Primary
112729
IA
Other
Enumeration date
06/20/2018
Last updated
06/09/2022
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