Individual
DIANE RENE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW-ACP
Contact information
Practice address
1129 HIGHTOWER PLACE DR, O FALLON, IL 62269-7069
(618) 628-0886
Mailing address
1129 HIGHTOWER PLACE DR, O FALLON, IL 62269-7069
(618) 628-0886
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
31356
TX
Other
Enumeration date
12/15/2006
Last updated
11/09/2007
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