Individual
JACKIE MARIE WOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
710 S 2ND ST, MANKATO, MN 56001-3810
(507) 625-7660
(507) 625-8998
Mailing address
710 S 2ND ST, MANKATO, MN 56001-3810
(507) 625-7660
(507) 625-8998
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CC01773
MN
101YP2500X
Professional Counselor
CC01773
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CC01773
LICENSED PROFESSIONAL CLINICAL COUNSELOR
MN
Enumeration date
05/03/2018
Last updated
08/12/2024
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