Jackson, Mary

Jackson, Mary is an individual health care provider with primary practice located at 4559 Benes Ave , Glen Carbon IL 62034-1541. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Behavioral Analyst, Behavioral Health & Social Service Providers / Assistant Behavior Analyst. Behavioral Health & Social Service Providers / Behavioral Analyst is her primary health care specialty. Jackson, Mary can be contacted via phone (217) 525-8332.

Contact Information

Primary practice address
4559 Benes Ave Glen Carbon IL 62034-1541
Phone: (217) 525-8332
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X 1-21-57035 Illinois
Behavioral Health & Social Service Providers / Assistant Behavior Analyst 106E00000X

Profile Details

NPI number 1275144149
LBN Legal business name Jackson, Mary
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 13th, 2020
Last updated Jul 3rd, 2023 - about last year

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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