Individual
LEEANN G JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
6525 GREEN BAY RD STE 2, KENOSHA, WI 53142-2967
(262) 999-3495
Mailing address
6525 GREEN BAY RD STE 2, KENOSHA, WI 53142-2967
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
16281-131
WI
101YP2500X
Professional Counselor
178009221
IL
101YP2500X
Professional Counselor
Primary
7126-125
WI
221700000X
Art Therapist
121-36
WI
Other
Enumeration date
06/28/2018
Last updated
06/03/2026
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