Individual
MS. JENNELL A JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
501 IRON BRIDGE RD, SUITE 15, FREEHOLD, NJ 07728-5304
(732) 784-8309
(732) 782-0429
Mailing address
501 IRON BRIDGE RD, SUITE 15, FREEHOLD, NJ 07728-5304
(732) 784-8309
(732) 782-0429
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
44SC05486000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
311452
MEDICARE PTAN
NJ
Enumeration date
06/26/2008
Last updated
03/23/2016
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