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General NPI Number Information
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NPI Number | 1790908788
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Entity Type | Individual
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Provider Name | KAREN ANN JACKA
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Gender | Female
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 08/27/2018
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Provider Practice Location Address
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Address Line | 404 W PINE ST STE 1
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City | LODI
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State | CA
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Zip | 95240
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Country | US
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Telephone | 209-483-6474
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Fax | 209-367-4696
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Provider Business Mailing Address
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Address Line | 21 S CALIFORNIA ST
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City | LODI
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State | CA
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Zip | 95240-1907
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Country | US
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Telephone | 209-483-6474
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Fax | 209-367-4696
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS16470
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License Number State | CA
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