Most Relevant Information
Provider Data
| NPI Number: | 1003328550 |
| Provider Name: | KENNETH LEE JACKSON LSW; LCDC III |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | S.1700069 |
Most Important Dates
| Enumeration Date: | 10/24/2017 |
| Last Updated: | 10/24/2017 |
Provider Practice Location
1430 S HIGH ST FL 4
COLUMBUS
OH
432071045
Practice Location Phone/Fax
| Phone: | 6144458131 |
| Fax: | 6146436820 |
Provider Mailing Location
1430 S HIGH ST FL 4
COLUMBUS
OH
432071045
Provider Mailing Phone/Fax
| Phone: | 6144458131 |
| Fax: | 6146436820 |