Jackson, Edna Elizabeth

Jackson, Edna Elizabeth is an individual health care provider with primary practice located at 1430 Olive St Ste 400 , Saint Louis MO 63103-2303. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Pastoral, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is her primary health care specialty. Jackson, Edna Elizabeth can be contacted via phone (314) 206-3700.

Contact Information

Primary practice address
1430 Olive St Ste 400 Saint Louis MO 63103-2303
Phone: (314) 206-3700
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Pastoral 101YP1600X
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X

Profile Details

NPI number 1265819213
LBN Legal business name Jackson, Edna Elizabeth
Credentials Master of Arts (MA)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 29th, 2015
Last updated Jul 28th, 2022 - about 4 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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Identifiers

StateTypeNumberIssuer
All States NPI 1265819213 NPPES
Missouri Other 630 CRADC

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