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1740532852
JELANI LEIF JACKSON
RENTON, WA
NPI
1740532852
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: WA LW 60607997)
Enumeration Date
2012-10-12
Last Update Date
2016-11-15
Business Address
Mr. JELANI LEIF JACKSON MSW, LICSW
419 S 2ND ST
RENTON, WA 98057
Phone number: 425-203-7203
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Mailing Address
Mr. JELANI LEIF JACKSON MSW, LICSW
419 S 2ND ST STE 2
RENTON, WA 98057-2234
Phone number: 425-203-7203
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