Individual
NANCY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LSW
Contact information
Practice address
701 JEFFERSON AVE, SUITE 301, TOLEDO, OH 43604-6955
(419) 321-6455
(419) 321-6452
Mailing address
701 JEFFERSON AVE, SUITE 301, TOLEDO, OH 43604-6955
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
SO600097
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750578530
—
OH
Enumeration date
12/27/2013
Last updated
12/27/2013
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