Provider Demographics
NPI:1669033551
Name:HOKANSON, JACKSON MICAH (SWLC)
Entity Type:Individual
Prefix:
First Name:JACKSON
Middle Name:MICAH
Last Name:HOKANSON
Suffix:
Gender:M
Credentials:SWLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 HUTTON RANCH RD
Mailing Address - Street 2:SUITE 103 #317
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2142
Mailing Address - Country:US
Mailing Address - Phone:406-471-4296
Mailing Address - Fax:
Practice Address - Street 1:30 E WASHINGTON ST STE A
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3967
Practice Address - Country:US
Practice Address - Phone:406-471-4296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-22
Last Update Date:2019-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-SWLC-LIC-332491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical