Individual
ANDREA K JACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2424 S 90TH ST, WEST ALLIS, WI 53227-2455
(414) 328-8700
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
4796
WI
101YP2500X
Professional Counselor
4796
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100186980
—
WI
Enumeration date
03/04/2010
Last updated
11/18/2024
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