Jackson Therapy
Social Worker, Clinical in Urbana, IL. Organization (NPI-2).
NPI number1164080693
StatusActive
Last updated in NPPESMar 30, 2023
Details
- NPI
- 1164080693
- Entity type
- Organization (NPI-2)
- Legal business name
- Jackson Therapy
- Organization subpart
- No
- Enumeration date
- May 30, 2019
- Certification date
- Mar 30, 2023
- Last updated
- Mar 30, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | – | – | Yes |
Practice location
404 W Green StUrbana, IL 61801-3267
Phone 217-706-5498 · Fax 217-706-5779
Mailing address
230 W Main StDecatur, IL 62523-1215
Phone 217-706-5498
Authorized official
Angela Jackson
Owner/Lead Therapist
2178404090
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