MS. NASTASSIA S JACKSON (NPI# 1720524341) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720524341 |
| Entity Type | Individual |
| Full Name | MS. NASTASSIA S JACKSON |
| Credential | LPC-IT |
| Practice Address |
6830 W Villard Ave Ste 190 Milwaukee WI 53218 |
| Mailing Address |
Po Box 12922 Milwaukee WI 53212-0922 |
| Practice Telephone | 2623207886 |
| Mailing Telephone | 4142656156 |
| Enumeration Date | 2017-01-07 |
| Last Update Date | 2019-06-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
7435 | WI | Behavioral Health & Social Service Providers |
| N | 101YM0800X |
Counselor Specialization: Mental Health |
2601 | WI | Behavioral Health & Social Service Providers |
| N | 101YS0200X |
Counselor Specialization: School |
Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 100071680 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3753 N 87th St, Milwaukee, WI 532222838 | 4142656156 |
| Street Address |
6830 W VILLARD AVE STE 190 |
| City | MILWAUKEE |
| State | WI |
| Zip Code | 53218 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336746452 | Heather Martin | Counselor | 6830 W Villard Ave Ste 190, Milwaukee, WI 53218-3968 | 2020-10-01 |
| 1770193187 | Heather Smith | Counselor | 6830 W Villard Ave Ste 190, Milwaukee, WI 53218-3968 | 2020-08-01 |
| 1164031522 | Danielle Elizabeth Newman | Counselor | 6830 W Villard Ave Ste 190, Milwaukee, WI 53218-3968 | 2020-07-30 |
| 1033772058 | Different Shades of Healing, LLC | Clinic/Center | 6830 W Villard Ave Ste 190, Milwaukee, WI 53218-3968 | 2019-04-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417571050 | Kaak Living | Clinic/Center | 5938 N 76th Street, Milwaukee, WI 53218 | 2020-05-29 |
| 1306495064 | Jeanette Bearden | Technician | 4477 N 57 St., Milwaukee, WI 53218 | 2019-09-05 |
| 1770074080 | Sunvale Homes LLC | Home Health | 4714 N 58th St, Milwaukee, WI 53218 | 2018-05-22 |
| 1447740006 | Quantum Care LLC | Home Health | 6424 W Fondulac Avenue, Unit 1, Milwaukee, WI 53218 | 2018-05-18 |
| 1811413008 | Ewura Asie Amonoo | Case Manager/Care Coordinator | 5153 W. Silver Spring, Milwaukee, WI 53218 | 2017-08-18 |
| 1649706714 | Life Tree Pharmacy LLC | Pharmacy | 8329-5 W Appleton Ave, Milwaukee, WI 53218 | 2017-05-10 |
| 1801330493 | Mary Beth Cafaro | Social Worker | 5555 N. 51st Blvd, Milwaukee, WI 53218 | 2016-12-15 |
| 1669823613 | Lasonya Carol Wilson | Licensed Practical Nurse | 5830 N 75th St, Milwaukee, WI 53218 | 2016-06-30 |
| 1225302243 | Drew Douglas Cannon | Social Worker | 5555 N 51st Street, Milwaukee, WI 53218 | 2012-03-08 |
| 1902183064 | Malissa L Washington | Registered Nurse | 7748 West Grantosa Drive, Milwaukee, WI 53218 | 2011-11-03 |
| Find all providers in zip 53218 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609481001 | Beth Leanna | Counselor | Benedict Center 1849 N Dr. Marin Luther King Dr., Suite 101, Milwaukee, WI 53212 | 2020-09-11 |
| 1477167658 | Aleksandra Miles Steinert | Counselor | 2025 E Greenwich Ave Unit 119, Milwaukee, WI 53211-4428 | 2020-09-03 |
| 1003420597 | Joshua A. Larson | Counselor | 316 N Milwaukee St Ste 325, Milwaukee, WI 53202-5895 | 2020-09-02 |
| 1407465701 | Lashana Marie Vance | Counselor | 1311 S 93rd St, Milwaukee, WI 53214-2714 | 2020-07-23 |
| 1295358430 | Karmelita Moore | Counselor | 620 N 76th St, Milwaukee, WI 53213-3508 | 2020-05-22 |
| 1245871557 | Neyel Powell | Counselor | 1849 N Martin Luther King Dr Ste 101, Milwaukee, WI 53212-3639 | 2019-10-08 |
| 1891255782 | Demetrius Levance Anderson Sr. | Counselor | 7732 N 80th St, Milwaukee, WI 53223-3810 | 2019-03-25 |
| 1639642382 | Shaquita Glenn | Counselor | 1845 N Farwell Ave Ste 301, Milwaukee, WI 53202-1715 | 2019-01-05 |
| 1992274070 | Amy Lynn Geyser | Counselor | 204 E Capitol Dr Ste 100, Milwaukee, WI 53212-1200 | 2018-11-18 |
| 1467931691 | The Salvation Army - Wisconsin and Upper Michigan | Counselor | 1730 N 7th Street, Milwaukee, WI 53205 | 2018-08-08 |
| Find all providers in MILWAUKEE | ||||
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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.