Individual
ADDISON JACKSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
4137 SAUK TRL STE 146, RICHTON PARK, IL 60471-1253
(708) 983-8074
Mailing address
3715 VILLAGE DR, HAZEL CREST, IL 60429-2444
(708) 983-8074
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149.021059
IL
Other
Enumeration date
09/13/2019
Last updated
03/09/2023
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