Provider Demographics
NPI:1326537663
Name:DALY, JACKSON
Entity Type:Individual
Prefix:MR
First Name:JACKSON
Middle Name:
Last Name:DALY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W SOUTH ST APT D25
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-1584
Mailing Address - Country:US
Mailing Address - Phone:732-608-4674
Mailing Address - Fax:
Practice Address - Street 1:550 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2645
Practice Address - Country:US
Practice Address - Phone:810-277-9618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional