Provider Demographics
NPI:1063782985
Name:JACKSON, JULIE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 E VERMONT ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3690
Mailing Address - Country:US
Mailing Address - Phone:317-289-1117
Mailing Address - Fax:317-631-5872
Practice Address - Street 1:429 E VERMONT ST
Practice Address - Street 2:SUITE 205
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3690
Practice Address - Country:US
Practice Address - Phone:317-289-1117
Practice Address - Fax:317-631-5872
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005111A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical