| Doctor Name: | NICOLE L. JACKSON |
| NPI Number: | 1144489261 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 15137-132 |
| Business Practice Address: | 8200 W Brown Deer Rd Suite 300a Brown Deer, WI - 532231706 |
| Business Phone Number: | 4143628147 |
| Business Fax Number: | 4143627198 |
| Mailing Address: | 285 N Janacek Rd, BROOKFIELD |
| State: | WI |
| Postal Code: | 530456102 |
| Phone Number: | 2626419050 |
| Fax Number: | |
| NPI Enumeration Date: | 06/04/2008 |
| NPI Last Update Date: | 07/10/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 15137-132 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |