Jackson, Kenneth Alan

Jackson, Kenneth Alan is an individual health care provider with primary practice located at 3329 University Ave Se , Minneapolis MN 55414-3325. He recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as his primary health care specialty. Jackson, Kenneth Alan can be contacted via phone (612) 454-2285.

Contact Information

Primary practice address
3329 University Ave Se Minneapolis MN 55414-3325
Phone: (612) 454-2285
Fax: (612) 454-2340
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 302997 Minnesota

Profile Details

NPI number 1891085783
LBN Legal business name Jackson, Kenneth Alan
Credentials BS, LADC
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 12th, 2011
Last updated Apr 12th, 2011 - about 15 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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