Provider Demographics
NPI:1700126232
Name:JACKSON, LAUREN (MSW, PCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MSW, PCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-2048
Mailing Address - Country:US
Mailing Address - Phone:307-233-2200
Mailing Address - Fax:307-233-2201
Practice Address - Street 1:2345 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2048
Practice Address - Country:US
Practice Address - Phone:307-233-2200
Practice Address - Fax:307-233-2201
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW-5321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical