Jackson, Sandra J

Jackson, Sandra J is an individual health care provider with primary practice located at 4218 Western Ave. , South Bend IN 46619. She recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as her primary health care specialty. Jackson, Sandra J can be contacted via phone (574) 233-1524.

Contact Information

Primary practice address
4218 Western Ave. South Bend IN 46619
Phone: (574) 233-1524
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 88000353A Indiana

Profile Details

NPI number 1124449053
LBN Legal business name Jackson, Sandra J
Credentials LCAC CADAC IV NADAC
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 19th, 2013
Last updated Dec 19th, 2013 - about 12 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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