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1518301597
BRENT L JACKSON
NAMPA, ID
NPI
1518301597
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
104100000X Social Worker
(Licence: ID 31373)
Enumeration Date
2013-04-22
Last Update Date
2013-04-22
Business Address
Mr. BRENT L JACKSON LMSW
1031 W SANETTA ST
NAMPA, ID 83651-5047
Phone number: 208-466-7443
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Mailing Address
Mr. BRENT L JACKSON LMSW
1031 W SANETTA ST
NAMPA, ID 83651-5047
Phone number: 208-466-7443
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