Individual
KIERAN L. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
850 N HARRISON ST, WARSAW, IN 46580-3163
(574) 267-7169
(574) 269-3995
Mailing address
2621 E JEFFERSON ST, WARSAW, IN 46580-3880
(574) 267-7169
(574) 269-4189
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
06/27/2017
Last updated
08/21/2020
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