Individual
JAN JACKSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Contact information
Practice address
1460 W MAIN ST, SUITE 6, SUN PRAIRIE, WI 53590-1846
(608) 837-4814
Mailing address
753 COUNTY RD N, STOUGHTON, WI 53589-4237
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1315
WI
101YM0800X
Mental Health Counselor
2519
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39118400
—
WI
Enumeration date
06/12/2006
Last updated
09/11/2025
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