KELLY FAYE JACKSON

COLUMBIA, MO
NPI1598180630
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy1041C0700X Social Worker, Clinical
(Licence: MO  2015020177)
Enumeration Date2014-02-26
Last Update Date2016-11-30
Business Address
-- KELLY FAYE JACKSON LCSW
409 VANDIVER DR BUILDING 4, SUITE 102
COLUMBIA, MO 65202-3754
Phone number: 573-289-0792
Mailing Address
-- KELLY FAYE JACKSON LCSW
3007 DAHLIA DR
COLUMBIA, MO 65202-3862
Phone number: 660-238-3154
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