Most Relevant Information
Provider Data
| NPI Number: | 1003366329 |
| Provider Name: | JACOB JERRY JACKSON PHD, LMHC, CADC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | 15081 |
Most Important Dates
| Enumeration Date: | 10/11/2016 |
| Last Updated: | 11/06/2023 |
Provider Practice Location
180 10TH ST SE STE 201
LE MARS
IA
510312557
Practice Location Phone/Fax
| Phone: | 7125464624 |
| Fax: | 7125469395 |
Provider Mailing Location
180 10TH ST SE
LE MARS
IA
510312559
Provider Mailing Phone/Fax
| Phone: | 7124990207 |
| Fax: |