Most Relevant Information
Provider Data
| NPI Number: | 1003521139 |
| Provider Name: | STEPHANIE SHERELLE JACKSON LCSW |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | 58542 |
Most Important Dates
| Enumeration Date: | 01/23/2023 |
| Last Updated: | 01/23/2023 |
Provider Practice Location
7538 DERBY VIS
SELMA
TX
781543943
Practice Location Phone/Fax
| Phone: | 8323622591 |
| Fax: |
Provider Mailing Location
7538 DERBY VIS
SELMA
TX
781543943
Provider Mailing Phone/Fax
| Phone: | 8323622591 |
| Fax: |