Provider Demographics
NPI:1194023903
Name:WELTON-JACSKON, MARCI ANN (PLADC)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:ANN
Last Name:WELTON-JACSKON
Suffix:
Gender:F
Credentials:PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2431
Mailing Address - Country:US
Mailing Address - Phone:402-436-2521
Mailing Address - Fax:402-441-3770
Practice Address - Street 1:120 WEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2431
Practice Address - Country:US
Practice Address - Phone:402-436-2521
Practice Address - Fax:402-441-3770
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-712101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)