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Individual

AMY JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
721 N CENTER DR NW, GRAND RAPIDS, MI 49544-8215
(616) 301-8000
Mailing address
1823 FRANCIS AVE SE, GRAND RAPIDS, MI 49507-2418

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6801103335
MI
104100000X
Social Worker
6802088547
MI
1041C0700X
Clinical Social Worker
6801103335
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
6801103335
LIMITED LICENSE
MI
01
6802088547
LLBSW
MI
Enumeration date
07/06/2015
Last updated
11/08/2018
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