KELLY COLLEEN JACKSON (NPI# 1629544655) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629544655 |
| Entity Type | Individual |
| Full Name | KELLY COLLEEN JACKSON |
| Credential | CDPT |
| Practice Address |
811 Madison St Everett WA 98203-4543 |
| Mailing Address |
Po Box 2569 Everett WA 98213-0569 |
| Practice Telephone | 4252124200 |
| Practice Fax Number | 4252124201 |
| Mailing Telephone | 4252124200 |
| Mailing Fax Number | 4252124201 |
| Enumeration Date | 2018-10-17 |
| Last Update Date | 2019-05-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
CO60869651 | WA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588036263 | Kelly Jackson | Social Worker | 2937 Ne 16th Ter, Gainesville, FL 32609-3234 | 2015-10-21 |
| 1477896876 | Kelly A Jackson | Occupational Therapist | 178 Manila Ave, Staten Island, NY 10306-5608 | 2013-04-03 |
| 1104986793 | Kelly A Jackson | Chiropractor | 190 North Main Street, Natick, MA 01760 | 2006-12-12 |
| 1518982487 | Kelly Donald Jackson | Dentist | 3023 Eastland Blvd Ste 112, Clearwater, FL 33761-4106 | 2006-07-13 |
| 1689273310 | Kelly Jackson | Behavior Technician | 27777 Inkster Rd Ste 100, Farmington Hills, MI 48334-5312 | 2020-10-23 |
| 1619457926 | Kelly Jackson | Physician Assistant | 12300 Mccracken Rd, Garfield Heights, OH 44125-2975 | 2018-08-16 |
| 1760961833 | Kelly D Jackson | Licensed Practical Nurse | 602 W Semands St, Conroe, TX 77301-1867 | 2018-08-09 |
| 1841780178 | Kelly Amanda Jackson | Nurse Practitioner | 1700 Medical Center Pkwy, Murfreesboro, TN 37129-2245 | 2018-05-11 |
| 1033653431 | Kelly Jackson | Nurse Practitioner | 606 W Columbia St, San Augustine, TX 75972-1709 | 2016-12-05 |
| 1497108310 | Kelly Jackson | Massage Therapist | 1325 San Marco Blvd, Suite 102, Jacksonville, FL 32207-8568 | 2016-07-15 |
| Street Address |
811 MADISON ST |
| City | EVERETT |
| State | WA |
| Zip Code | 98203-4543 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932140985 | Sondra Lee Laverne | Counselor | 811 Madison St, Everett, WA 98203-4543 | 2006-06-09 |
| 1891394623 | Raymond Francis Lacko Jr. | Counselor | 811 Madison St, Everett, WA 98203-4543 | 2020-10-22 |
| 1356940480 | Dennis R Phillips | Counselor | 811 Madison St, Everett, WA 98203-4543 | 2020-10-20 |
| 1285243956 | Lauran Elizabeth Tapp | Counselor | 811 Madison St, Everett, WA 98203-4543 | 2020-07-28 |
| 1154930147 | Alexa T Nachreiner | Counselor | 811 Madison St, Everett, WA 98203-4543 | 2020-07-27 |
| 1134738222 | Jonathan Thomas Wallis | Counselor | 811 Madison St, Everett, WA 98203-4543 | 2020-07-24 |
| 1659998417 | Corilynne Woods | Counselor | 811 Madison St, Everett, WA 98203-4543 | 2020-06-28 |
| 1942825781 | Lauren F Wilson | Counselor | 811 Madison St, Everett, WA 98203-4543 | 2020-06-08 |
| 1669096913 | Meghan Irene Rose White | Counselor | 811 Madison St, Everett, WA 98203-4543 | 2020-06-02 |
| 1285257790 | Susan Sarrazin | Counselor | 811 Madison St, Everett, WA 98203-4543 | 2020-05-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083226039 | Lisa Mcgregor | Counselor | Sea Mar Community Health Centers, 5007 Claremont Way, Everett, WA 98203 | 2020-08-20 |
| 1417572009 | Megan Ostermick-durkee | Student in an Organized Health Care Education/Training Program | Sunrise Services Inc., 811 Madison Street, Everett, WA 98203 | 2020-06-10 |
| 1134741424 | Tara Lin Garcia | Peer Specialist | 4256 Federal Avenue, Everett, WA 98203 | 2020-05-11 |
| 1225505241 | Reverie Aurora Shunny | Counselor | Sunrise Service Inc., 811 Madison Street, Everett, WA 98203 | 2018-10-29 |
| 1205313483 | Kristina Renee Bylenga | Counselor | Compass Health 4526 Federal Avenue M/s # 11, Everett, WA 98203 | 2018-07-20 |
| 1306384300 | Shantijoy Inc | Naturopath | 5208 S 2nd Ave, Everett, WA 98203 | 2017-02-09 |
| 1922545276 | Ekaterina Malinovska Dds Pllc | Dentist | 5920 Evergreen Way Suite E, Everett, WA 98203 | 2017-01-25 |
| 1326404104 | Job Oichoe | Counselor | 4625 Federal Ave, Everett, WA 98203 | 2016-01-08 |
| 1427423292 | Ross Lee Voorhees | Counselor | 4423 S 3rd Ave, Everett, WA 98203 | 2015-12-04 |
| 1447642376 | Adam Schneider | Counselor | 4526 Federal Ave # 40, Everett, WA 98203 | 2015-03-02 |
| Find all providers in zip 98203 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124664172 | Deidre Michelle Greene | Counselor | 13105 21st Dr Se Apt E307, Everett, WA 98208-7173 | 2019-11-25 |
| 1356859623 | Victor Cleveland | Counselor | 10315 19th Ave Se Ste 112, Everett, WA 98208-4268 | 2018-01-19 |
| 1386155893 | Kristin Zarrello | Counselor | 11008 20th Dr Se, Everett, WA 98208-5241 | 2017-10-24 |
| 1861927949 | Melanie Schmidt | Counselor | 2610 Westmore Ave, Everett, WA 98201 | 2017-04-26 |
| 1619401973 | David Alexander | Counselor | 10905 3rd Ave Se, Everett, WA 98208-7020 | 2017-04-13 |
| 1982152955 | Adekunbi Afusat Olukoya | Counselor | 8625 Evergreen Way Ste 108, Everett, WA 98208-2647 | 2016-09-19 |
| 1588012694 | Tammy J Laird | Counselor | 9300 Evergreen Way, Everett, WA 98204 | 2016-05-31 |
| 1902269418 | Clay Eakin | Counselor | 2732 Grand Evenue, Everett, WA 98208 | 2016-04-01 |
| 1891157798 | Pamela Hubbard | Counselor | 3501 Colby Ave Ste 105, Everett, WA 98201-4795 | 2016-03-22 |
| 1881052280 | Jolene Eva Janacek | Counselor | 1811 Mcdougall Ave, Everett, WA 98201-2456 | 2016-02-01 |
| Find all providers in EVERETT | ||||
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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.