National Provider Identifier Database

LEEANN G JACKSON, ATR – NPI #1790270049
Professional


Contact Information

LEEANN G JACKSON, ATR
1910 COUNTY ROAD NN
ELKHORN, WI53121-4454
Phone: 262-741-3200
Fax: 262-741-3217
Website:
Specialty Taxonomy Code
* Professional 101YP2500X
Addiction (Substance Use Disorder) 101YA0400X
Art Therapist 221700000X

* Indicates primary specialty

NPI Profile & details for LEEANN G JACKSON

NPI Number 1790270049
Credentials ATR
Entity Individual
Enumeration date 06/28/2018
Last updated 03/13/2023 - About 3 years ago
Sole proprietor1 No
Identifiers
  • IL License #: 178009221
  • WI License #: 121-36
  • WI License #: 16281-131
  • WI License #: 7126-125
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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