MR. JERRY MICHAEL JACKSON (NPI# 1699887166) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1699887166 |
Entity Type | Individual |
Full Name | MR. JERRY MICHAEL JACKSON |
Credential | MSW, ACSW |
Practice Address |
11016 Ne 2nd Pl Bellevue WA 98004-5830 |
Mailing Address |
3723 Ne 150th St Lake Forest Park WA 98155-7828 |
Practice Telephone | 4254550348 |
Practice Fax Number | 2063670547 |
Mailing Telephone | 2063673351 |
Mailing Fax Number | 2063670547 |
Enumeration Date | 2006-08-31 |
Last Update Date | 2007-07-08 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 101YM0800X |
Counselor Specialization: Mental Health |
LW00004286 | WA | Behavioral Health & Social Service Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
WA | LICENSED SOCIAL WORKER | LW00004286 | 01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1023549805 | Jerry Jackson | Social Worker | 7937 Westmoreland Ave, Parkville, MD 21234-5435 | 2017-03-23 |
1154423234 | Jerry S Jackson | Podiatrist | 300 Aztec St, Montezuma, KS 67867 | 2006-09-01 |
1386632081 | Jerry D Jackson | Pharmacist | 415 Springwood Dr, Spartanburg, SC 29302-4047 | 2005-10-07 |
1265994313 | Jerry Scott Jackson | Hearing Instrument Specialist | 2601 S Ih 35 Ste A300, Round Rock, TX 78664-7358 | 2019-04-05 |
1083097901 | Jerry Louis Jackson Jr. | Marriage & Family Therapist | 801 W 70th St, Los Angeles, CA 90044-5218 | 2015-07-09 |
1902053549 | Jerry Jackson | Registered Nurse | 1830 Flower St, Bakersfield, CA 93305-4144 | 2008-08-26 |
1821261355 | Jerry W Jackson | Pharmacist | 801 Stadium Dr, Suite # 111, Arlington, TX 76011-6254 | 2008-04-04 |
1881874584 | Jerry Jay Jackson | Internal Medicine | 3134 Northside Dr, Bldg B, Key West, FL 33040-8004 | 2007-11-09 |
1528182102 | Jerry Camal Jackson | Counselor | 1321 S Fayette St, Saginaw, MI 48602-1447 | 2007-03-19 |
1356423594 | Jerry Edwin Jackson Jr. | Counselor | 3963 Market Street, Suite A, Wilmington, NC 28403 | 2006-10-19 |
Street Address |
11016 NE 2ND PL |
City | BELLEVUE |
State | WA |
Zip Code | 98004-5830 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1467560243 | Suzanne S Blinstrub | Counselor | 11016 Ne 2nd Pl, Bellevue, WA 98004-5830 | 2006-08-29 |
1043418718 | Barbara Ryan | Counselor | 11016 Ne 2nd Pl, Bellevue, WA 98004-5830 | 2007-07-04 |
1306042643 | Diane M Scoville | Psychologist | 11016 Ne 2nd Pl, Bellevue, WA 98004-5830 | 2007-06-25 |
1710004130 | George T. Lynn | Counselor | 11016 Ne 2nd Pl, Bellevue, WA 98004-5830 | 2007-03-22 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1306458328 | Geneva Paula Hoskins-dorsey | Nurse Practitioner | 11120 Ne 33rd Place, Suite 202, Bellevue, WA 98004 | 2020-08-20 |
1720553613 | Christine Eyler | Pediatrics | Bellevue Pediatrics, C & C Medical Associates, 1940 116th Ave Ne, Ste 200, Bellevue, WA 98004 | 2018-10-08 |
1437634730 | Hazelden Betty Ford Foundation | Clinic/Center | 1231 116th Ave. Ne Suite 410, Bellevue, WA 98004 | 2018-10-02 |
1356827828 | Seattle Spine Group, Pllc | Orthopaedic Surgery | 1220 116th Ave Ne Ste 102, Bellevue, WA 98004 | 2018-07-17 |
1669989216 | Atsuko Nakajima | Acupuncturist | 2223 112th Ave. Ne, Ste 201, Bellevue, WA 98004 | 2018-01-04 |
1740794718 | Radka Chapin Counseling, LLC | Clinic/Center | 1611 116th Ave Ne Ste 119, Bellevue, WA 98004 | 2017-11-28 |
1962912105 | Cuyler Ann Simmons | Counselor | 3805 108th Ave Ne Ste 204, Bellevue, WA 98004 | 2017-10-02 |
1639690357 | Nicolas Lopez-montalvo | Behavioral Analyst | 3003 Northup Way Suite 200, Bellevue, WA 98004 | 2017-07-03 |
1124579537 | Matthew Thomas Haley | Pharmacist | 107 Bellevue Way, Se, Bellevue, WA 98004 | 2016-10-20 |
1649727348 | Kelsey Tanaka | Nurse Practitioner | 400- 108th Ave Ne, Suite 100, Bellevue, WA 98004 | 2016-09-10 |
Find all providers in zip 98004 |
Taxonomy Code | 101YM0800X |
Grouping | Behavioral Health & Social Service Providers |
Classification | Counselor |
Specialization | Mental Health |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1255931416 | Lauren Dudugjian | Counselor | 1160 140th Ave Ne Ste E-f, Bellevue, WA 98005-2978 | 2020-10-27 |
1760080345 | Carli Rhylander | Counselor | 2009 Nottingham Dr, Bellevue, NE 68123-2046 | 2020-10-15 |
1023621877 | Eileen S Putter | Counselor | 14011 Se 49th Pl, Bellevue, WA 98006-3401 | 2020-08-30 |
1326657164 | Tamasin Raiswell | Counselor | 1611 116th Ave Ne Ste 211, Bellevue, WA 98004-3064 | 2020-07-28 |
1194349415 | Le Center for Health & Wellness, Inc. | Counselor | 15015 Main St Ste 210, Bellevue, WA 98007-5229 | 2020-06-02 |
1447888326 | Carlos M Del Rio | Counselor | 4009 Raynor Pkwy Apt 2120, Bellevue, NE 68123-6103 | 2020-03-27 |
1386270221 | Danthony T Smith | Counselor | 10608 Ne 2nd St, Bellevue, WA 98004-5157 | 2020-03-22 |
1538708169 | Anna L Redgrave | Counselor | 15659 Se 9th St, Bellevue, WA 98008-4901 | 2019-12-30 |
1508401142 | Jennifer Flores | Counselor | 3145 Whiteman Dr, Bellevue, NE 68123-1625 | 2019-11-07 |
1861037467 | Alyssa Rose Overton | Counselor | 1231 116th Ave Ne Ste 410, Bellevue, WA 98004-3804 | 2019-11-07 |
Find all providers in BELLEVUE |
Please comment or provide details below to improve the information on MR. JERRY MICHAEL 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.