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General NPI Number Information
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NPI Number | 1154942753
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Entity Type | Individual
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Provider Name | KALUNDRA S JACKSON LMSW
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Gender | Female
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Dates
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Enumeration Date | 05/05/2020
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Last Update Date | 05/05/2020
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Provider Practice Location Address
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Address Line | 42382 DELUXE PLZ STE 34
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City | HAMMOND
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State | LA
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Zip | 70403-1236
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Country | US
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Telephone | 985-956-7378
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Fax |
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Provider Business Mailing Address
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Address Line | 45125 DURBIN RD UNIT A
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City | HAMMOND
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State | LA
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Zip | 70401-4484
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Country | US
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Telephone | 985-320-8792
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 11685
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License Number State | LA
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