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1740925825
SUSAN JACKSON
CHAMPAIGN, IL
NPI
1740925825
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Former Name
SUSAN IDZIAK
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
Enumeration Date
2022-05-03
Last Update Date
2022-05-03
Business Address
SUSAN JACKSON LCSW
2301 W BRADLEY AVE
CHAMPAIGN, IL 61821-1849
Phone number: 574-387-4313
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Mailing Address
SUSAN JACKSON LCSW
1824 TOUBY PIKE STE B
KOKOMO, IN 46901-2573
Phone number: 765-628-7400
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