Individual
MR. KENNETH ALAN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BS, LADC
Contact information
Practice address
3329 UNIVERSITY AVE SE, MINNEAPOLIS, MN 55414-3325
(612) 454-2285
(612) 454-2340
Mailing address
3329 UNIVERSITY AVE SE, MINNEAPOLIS, MN 55414-3325
(612) 454-2285
(612) 454-2340
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
302997
MN
Other
Enumeration date
04/12/2011
Last updated
04/12/2011
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