Jackson, Warren T

Jackson, Warren T is an individual health care provider with primary practice located at 408 E Vine St , Vienna IL 62995-1612. He recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as his primary health care specialty. Jackson, Warren T can be contacted via phone (618) 658-2611.

Contact Information

Primary practice address
408 E Vine St Vienna IL 62995-1612
Phone: (618) 658-2611
Fax: (618) 658-2501
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X

Profile Details

NPI number 1811088057
LBN Legal business name Jackson, Warren T
Credentials QMRP, MHP
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 27th, 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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