Wood, Jackie Marie

Wood, Jackie Marie is an individual health care provider with primary practice located at 710 S 2Nd St , Mankato MN 56001-3810. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Wood, Jackie Marie can be contacted via phone (507) 625-7660.

Contact Information

Primary practice address
710 S 2Nd St Mankato MN 56001-3810
Phone: (507) 625-7660
Fax: (507) 625-8998
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X CC01773 Minnesota
Behavioral Health & Social Service Providers / Mental Health 101YM0800X CC01773 Minnesota

Profile Details

NPI number 1790274959
LBN Legal business name Wood, Jackie Marie
Credentials LPCC
Entity Individual
Sole proprietor 1 No
Enumeration date May 3rd, 2018
Last updated Aug 12th, 2024 - about 2 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 1790274959 NPPES
Minnesota Other CC01773 LICENSED PROFESSIONAL CLINICAL COUNSELOR

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