JOANN MICHELLE JACKSON (NPI# 1194739904) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194739904 |
| Entity Type | Individual |
| Full Name | JOANN MICHELLE JACKSON |
| Credential | PSY.D. |
| Practice Address |
403 E Madison St South Bend IN 46617-2322 |
| Mailing Address |
330 Lakeview Dr Goshen IN 46528-9365 |
| Practice Telephone | 5745331234 |
| Practice Fax Number | 5745372652 |
| Mailing Telephone | 5745331234 |
| Mailing Fax Number | 5745372652 |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2010-09-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | 20040982A | IN | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200200700A | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194971853 | Joann Jackson | Occupational Therapy Assistant | 3442 W 73rd Pl, Chicago, IL 60629-3514 | 2008-08-13 |
| 1891218152 | Joann Jackson | Nurse Practitioner | 127 Anderson St Ste 101, Pittsburgh, PA 15212-5803 | 2017-07-19 |
| 1265755524 | Joann Kate Jackson | Physician Assistant | 1099 Medical Center Dr, Suite 201, Wilmington, NC 28401-7346 | 2010-03-01 |
| 1487701926 | Joann A Jackson | Obstetrics & Gynecology | 1145 19th St Nw, #410, Washington, DC 20036 | 2007-01-05 |
| 1588765630 | Joann Jackson | Internal Medicine | 9500 Euclid Ave, Cleveland, OH 44195-0001 | 2006-09-25 |
| Street Address |
403 E MADISON ST |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46617-2322 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164497962 | Phillip Coffey | Social Worker | 403 E Madison St, South Bend, IN 46617-2322 | 2006-02-23 |
| 1134534456 | Memorial Hospital of South Bend, Inc | General Acute Care Hospital | 403 E Madison St, South Bend, IN 46617-2322 | 2014-06-25 |
| 1225310402 | Susan K Henderson | Counselor | 403 E Madison St, South Bend, IN 46617-2322 | 2011-09-14 |
| 1154633550 | Meladie A Langham | Counselor | 403 E Madison St, South Bend, IN 46617-2322 | 2010-07-14 |
| 1497067896 | Kami S Brenneman | Counselor | 403 E Madison St, South Bend, IN 46617-2322 | 2010-07-14 |
| 1396064309 | Casandra Mcgrew | Counselor | 403 E Madison St, South Bend, IN 46617-2322 | 2010-06-01 |
| 1124347133 | Amanda Jardine | Counselor | 403 E Madison St, South Bend, IN 46617-2322 | 2010-06-01 |
| 1104141985 | Aaron T Gray | Counselor | 403 E Madison St, South Bend, IN 46617-2322 | 2010-04-05 |
| 1346579679 | Linda S Hoppel | Counselor | 403 E Madison St, South Bend, IN 46617-2322 | 2009-12-16 |
| 1235468570 | Michelle M Peters | Social Worker | 403 E Madison St, South Bend, IN 46617-2322 | 2009-12-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740731116 | Jack Mcintyre Kimmell | Specialist/Technologist | 1526 East Lasalle, South Bend, IN 46617 | 2016-10-20 |
| 1023429115 | Morning View Assisted Living LLC | Assisted Living Facility | 475 N. Niles Avenue, South Bend, IN 46617 | 2014-05-12 |
| 1265861231 | Rebecca Busenbark | Physical Therapist | 401 E Colfax Ave Ste 102, South Bend, IN 46617 | 2013-11-11 |
| 1962709071 | Doreen Danice Huddleston | Social Worker | 928 East Wayne St, Suit C, South Bend, IN 46617 | 2011-02-25 |
| 1487981734 | Mary Cecilia Roemer | Marriage & Family Therapist | 616 E. Colfax Ave, South Bend, IN 46617 | 2009-11-06 |
| 1225264054 | Sridhar Meda | Dentist | 1005 East Lasalle Ave, South Bend, IN 46617 | 2009-06-08 |
| 1063673531 | Madeline Christina Watkins | Counselor | 616 E Colfax, South Bend, IN 46617 | 2008-06-18 |
| 1437366481 | Michael Reed Johns | Dentist | 103 South Eddy Street, South Bend, IN 46617 | 2007-05-17 |
| 1194937680 | Sarah Elizabeth Redman | Specialist/Technologist | 53880 Carmichael Dr., South Bend, IN 46617 | 2007-05-04 |
| 1124241211 | Trixy Franke | Family Medicine | 837 E. Cedar St., Ste 100, South Bend, IN 46617 | 2007-04-10 |
| Find all providers in zip 46617 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649580911 | Daniel Scott Debrule | Psychologist | 211 W. Washington Street, Suite 2311, South Bend, IN 46601 | 2010-10-20 |
| 1144498353 | Academic Solutions of Michiana, Inc | Psychologist | 2012 Ironwood Circle, South Bend, IN 46635-1888 | 2008-02-11 |
| 1851491526 | John Anthony Petersen | Psychologist | 922 E Wayne St # 205, South Bend, IN 46617-3024 | 2006-09-23 |
| 1841308756 | Joyce Block | Psychologist | 300 North Michigan St #208, South Bend, IN 46601 | 2006-08-29 |
| 1982632329 | Jeffrey T Feathergill | Psychologist | 211 W Washington St Ste 2311, South Bend, IN 46601-1708 | 2006-06-28 |
| 1851860878 | Afc Psychological Services, LLC | Psychologist | 1251 N Eddy St Ste 200, South Bend, IN 46617-1478 | 2018-11-20 |
| 1275083768 | Heidi Jo Krug | Psychologist | 2955 Mckinley Ave, Suite C, South Bend, IN 46615-2733 | 2016-10-07 |
| 1295181154 | James Fenstermacher | Psychologist | 112 W Jefferson Blvd, Ste 600, South Bend, IN 46601-1923 | 2016-05-10 |
| 1598145484 | William Bruinsma | Psychologist | 1000 S Michigan St, South Bend, IN 46601-3426 | 2015-06-04 |
| 1952794570 | Matthew Jackson | Psychologist | 714 N Michigan St, South Bend, IN 46601-1035 | 2015-03-06 |
| Find all providers in SOUTH BEND | ||||
| City | SOUTH BEND |
| Zip Code | 46617 |
Please comment or provide details below to improve the information on JOANN MICHELLE JACKSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.