Individual
JAY BRIAN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
13722 JEFFERSON RD, RUSSELLVILLE, MO 65074-2006
(573) 782-0145
Mailing address
13722 JEFFERSON RD, RUSSELLVILLE, MO 65074-2006
(573) 338-2861
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2002031992
MO
Other
Enumeration date
11/30/2021
Last updated
11/30/2021
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