Individual
MR. JELANI LEIF JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, LICSW
Contact information
Practice address
419 S 2ND ST, RENTON, WA 98057
(425) 203-7203
Mailing address
419 S 2ND ST STE 2, RENTON, WA 98057-2234
(425) 203-7203
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LW 60607997
WA
Other
Enumeration date
10/12/2012
Last updated
11/15/2016
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