Jackson, Jan

Jackson, Jan is an individual health care provider with primary practice located at 1460 W Main St Suite 6, Sun Prairie WI 53590-1846. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is his primary health care specialty. Jackson, Jan can be contacted via phone (608) 837-4814.

Contact Information

Primary practice address
1460 W Main St Suite 6 Sun Prairie WI 53590-1846
Phone: (608) 837-4814
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 1315 Wisconsin
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 2519 Wisconsin

Profile Details

NPI number 1871535047
LBN Legal business name Jackson, Jan
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 12th, 2006
Last updated Jul 8th, 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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Identifiers

StateTypeNumberIssuer
All States NPI 1871535047 NPPES
Wisconsin MEDICAID 39118400

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