| Doctor Name: | MS. GRETCHEN D JACKSON |
| NPI Number: | 1780822734 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC |
| License Number: | 018-006325 |
| Business Practice Address: | 2 Terminal Dr Suite 8 East Alton, IL - 620242201 |
| Business Phone Number: | 6182580485 |
| Business Fax Number: | 6182584815 |
| Mailing Address: | 2 Terminal Dr, Suite 8 EAST ALTON |
| State: | IL |
| Postal Code: | 620242201 |
| Phone Number: | 6182580485 |
| Fax Number: | 6182584815 |
| NPI Enumeration Date: | 01/29/2009 |
| NPI Last Update Date: | 01/29/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 018-006325 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |