| Doctor Name: | MRS. AMY MICHELLE JACKSON |
| NPI Number: | 1407914328 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW, LCSW, ACSW |
| License Number: | 2003024017 |
| Business Practice Address: | 225 W Hayden St Suite 210 Marceline, MO - 646581049 |
| Business Phone Number: | 6603763200 |
| Business Fax Number: | 6603763204 |
| Mailing Address: | 710 West Broadway, BRUNSWICK |
| State: | MO |
| Postal Code: | 65236 |
| Phone Number: | 6606342380 |
| Fax Number: | 6603763204 |
| NPI Enumeration Date: | 12/04/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 2003024017 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |