KENNETH D JACKSON (NPI# 1457857690) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457857690 |
| Entity Type | Individual |
| Full Name | KENNETH D JACKSON |
| Credential | CDCA |
| Practice Address |
2775 State Route 39 Shelby OH 44875-9466 |
| Practice Telephone | 4197473322 |
| Mailing Telephone | 4197473322 |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2018-04-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
166031 | OH | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174083810 | Kenneth Jason Jackson | Student in an Organized Health Care Education/Training Program | 320 23rd St S Apt 1418, Arlington, VA 22202-3773 | 2019-03-20 |
| 1639469026 | Kenneth T Jackson | Counselor | 25506 Virginia Dr, Warren, MI 48091-6002 | 2011-04-19 |
| 1396968863 | Kenneth J Jackson | Dentist | 809 Redskin Trail, Wapakoneta, OH 45895 | 2007-04-11 |
| 1972510352 | Kenneth Wayne Jackson | Nurse Practitioner | 1811 Memorial Dr, Clarksville, TN 37043-4604 | 2006-08-01 |
| 1487606943 | Kenneth Wade Jackson Jr. | Obstetrics & Gynecology | 22 Manningfield Dr, Fletcher, NC 28732-9457 | 2006-05-16 |
| 1275514994 | Kenneth Conrad Jackson II | Pharmacist | 546 Chipeta Way, Suite 220, Salt Lake City, UT 84108-1236 | 2005-11-09 |
| 1407409063 | Kenneth Jackson | Technician | 1005 Terminal Way Ste 125, Reno, NV 89502-2198 | 2019-07-22 |
| 1528573714 | Kenneth Jackson | Case Manager/Care Coordinator | 1501 Madison Rd, Walnut Hills, OH 45206-1706 | 2017-12-10 |
| 1003328550 | Kenneth Lee Jackson Jr. | Counselor | 1430 S High St Fl 4, Columbus, OH 43207-1045 | 2017-10-24 |
| 1942674411 | Kenneth David Jackson Jr. | Case Manager/Care Coordinator | 3901 Ulloa St, New Orleans, LA 70119-6942 | 2015-11-21 |
| Street Address |
2775 STATE ROUTE 39 |
| City | SHELBY |
| State | OH |
| Zip Code | 44875-9466 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376518902 | Cornell Abraxas Group, Inc. | Clinic/Center | 2775 State Route 39, Shelby, OH 44875-9466 | 2006-02-17 |
| 1033726039 | Paige Snyder | Counselor | 2775 State Route 39, Shelby, OH 44875-9466 | 2020-09-24 |
| 1598370751 | Erin Ball | Counselor | 2775 State Route 39, Shelby, OH 44875-9466 | 2020-09-14 |
| 1689289860 | Josh Alamanteoff | Counselor | 2775 State Route 39, Shelby, OH 44875-9466 | 2020-09-14 |
| 1891306783 | Destinee Oney | Licensed Practical Nurse | 2775 State Route 39, Shelby, OH 44875-9466 | 2020-08-13 |
| 1548878283 | Kaitlyn Lamb | Counselor | 2775 State Route 39, Shelby, OH 44875-9466 | 2020-07-20 |
| 1083239594 | Jospeh Norris | Counselor | 2775 State Route 39, Shelby, OH 44875-9466 | 2020-06-10 |
| 1962027474 | Joseph Goracke | Counselor | 2775 State Route 39, Shelby, OH 44875-9466 | 2020-06-10 |
| 1962022814 | Jacquille Fletcher | Counselor | 2775 State Route 39, Shelby, OH 44875-9466 | 2020-04-21 |
| 1386263036 | Mary Metoyer | Licensed Practical Nurse | 2775 State Route 39, Shelby, OH 44875-9466 | 2020-04-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962999755 | Michael Lee Mason | Counselor | 2779 St. Rt. 39, Shelby, OH 44875 | 2018-04-17 |
| 1336646009 | Toia Branklin | Counselor | 2779 St Rt 39, Shelby, OH 44875 | 2018-04-10 |
| 1801397138 | Stephanie L Kamp | Social Worker | 29 Steele Ave, Shelby, OH 44875 | 2018-02-22 |
| 1164956744 | Brandy Brown | Licensed Practical Nurse | 2775 St. Rt. 39, Shelby, OH 44875 | 2017-04-20 |
| 1306229281 | Spencer Blevins | Specialist/Technologist | 7025 State Route 61 N, Shelby, OH 44875 | 2015-07-09 |
| 1194141150 | Karen Rittenhouse | Occupational Therapist | 109 Auburn Ave., Auburn Elementary, Shelby, OH 44875 | 2014-03-13 |
| 1467877100 | Adrianne Stumbo | Licensed Practical Nurse | 2708 Holtz Rd, Shelby, OH 44875 | 2014-03-04 |
| 1730452608 | Amy Marie Weiner | Community Health Worker | 225 West Main Street, Shelby, OH 44875 | 2012-02-22 |
| 1093038218 | Susan K Mcfarland | Licensed Practical Nurse | 77 Grand Blvd Ext, Shelby, OH 44875 | 2010-03-02 |
| 1427289362 | Mary Catherine Finnegan | Physical Therapy Assistant | 60 Grand Blvd Apt 1, Shelby, OH 44875 | 2009-07-27 |
| Find all providers in zip 44875 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962999755 | Michael Lee Mason | Counselor | 2779 St. Rt. 39, Shelby, OH 44875 | 2018-04-17 |
| 1336646009 | Toia Branklin | Counselor | 2779 St Rt 39, Shelby, OH 44875 | 2018-04-10 |
| 1790200541 | Robin Lynn Laine | Counselor | 529 Park Ave, Shelby, MT 59474-2131 | 2017-08-12 |
| 1659895977 | Hope Billings | Counselor | 501 N Lafayette St, Shelby, NC 28150-4476 | 2017-07-28 |
| 1386179802 | Kenneth Young | Counselor | 169 Mansfield Ave, Shelby, OH 44875-1832 | 2017-04-21 |
| 1184166944 | Collette Scruggs | Counselor | 200-2 South Post Road, Shelby, NC 28152 | 2016-11-10 |
| 1851763957 | Kathy Sue Allen | Counselor | 941 E Marion St, Shelby, NC 28150-4740 | 2015-10-28 |
| 1144512872 | Sydney M Phipps | Counselor | 1201 S Post Rd # 100, Shelby, NC 28152 | 2011-05-13 |
| 1023250636 | Robert Andrew Mccully Jr. | Counselor | 1243 E Dixon Blvd, Shelby, NC 28152-6978 | 2009-03-27 |
| 1962653873 | Professional Care LLC | Counselor | 320 E Graham St, Suite 1, Shelby, NC 28150-5568 | 2008-10-09 |
| Find all providers in SHELBY | ||||
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| 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.