MR. JERRY MICHAEL JACKSON


Address: 11016 Ne 2nd Pl, Bellevue, WA 98004-5830
Phone: 4254550348

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 101YM0800X Counselor
Specialization: Mental Health
LW00004286 WA Behavioral Health & Social Service Providers

Other Provider Identifier

State Issuer Identifier Type Code
WA LICENSED SOCIAL WORKER LW00004286 01

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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

Office Location

Street Address 11016 NE 2ND PL
City BELLEVUE
State WA
Zip Code 98004-5830

Providers in the same location

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

Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 101YM0800X
Grouping Behavioral Health & Social Service Providers
Classification Counselor
Specialization Mental Health

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

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
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Competitor

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City BELLEVUE
Zip Code 98004

Improve Information

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Dataset Information

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.

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