Jackson, Diane Rene
Jackson, Diane Rene is an individual health care provider with primary practice located at 1129 Hightower Place Dr , O Fallon IL 62269-7069. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Jackson, Diane Rene can be contacted via phone (618) 628-0886.Contact Information
Primary practice address
1129 Hightower Place Dr
O Fallon IL 62269-7069
Phone: (618) 628-0886
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 31356 | Texas |
Profile Details
| NPI number | 1922160720 |
|---|---|
| LBN Legal business name | Jackson, Diane Rene |
| Credentials | LMSW-ACP |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 15th, 2006 |
| Last updated | Nov 9th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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