Provider Demographics
NPI:1720312416
Name:DAY, JACKIE SUZANNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:SUZANNE
Last Name:DAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JACKIE
Other - Middle Name:SUZANNE
Other - Last Name:KEISKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1101 JACKSON ST SW
Mailing Address - Street 2:
Mailing Address - City:GRAVETTE
Mailing Address - State:AR
Mailing Address - Zip Code:72736-9121
Mailing Address - Country:US
Mailing Address - Phone:479-787-5221
Mailing Address - Fax:479-787-5613
Practice Address - Street 1:1101 JACKSON ST SW
Practice Address - Street 2:
Practice Address - City:GRAVETTE
Practice Address - State:AR
Practice Address - Zip Code:72736-9121
Practice Address - Country:US
Practice Address - Phone:479-787-5221
Practice Address - Fax:479-787-5613
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3995-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical