Provider Demographics
NPI:1184966459
Name:JACKSON, CHELSEA M (LMSW)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:M
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 N PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4149
Mailing Address - Country:US
Mailing Address - Phone:316-734-5223
Mailing Address - Fax:316-494-6348
Practice Address - Street 1:236 N PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4149
Practice Address - Country:US
Practice Address - Phone:316-734-5223
Practice Address - Fax:316-494-6348
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS8768104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker