SHANNA JACKSON (NPI# 1922492594) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922492594 |
| Entity Type | Individual |
| Full Name | SHANNA JACKSON |
| Credential | LLPC |
| Practice Address |
38271 Mound Rd Bldg B Sterling Heights MI 48310-3401 |
| Mailing Address |
585 Jewett Rd Mason MI 48854-8729 |
| Practice Telephone | 5864772054 |
| Mailing Telephone | 5176765405 |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2020-10-07 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
Behavioral Health & Social Service Providers | ||
| N | 171M00000X | Case Manager/Care Coordinator | 6401013761 | MI | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710506472 | Shanna Shaneen Jackson | Registered Nurse | 12815 Heacock St, Moreno Valley, CA 92553-2836 | 2020-04-13 |
| 1154845055 | Shanna Marie Jackson | Chiropractor | 105 E Main St, Bullard, TX 75757-5345 | 2017-08-01 |
| 1710197769 | Shanna Jackson | Technician, Other | 474 W 200 N, Suite 100, St George, UT 84770-4505 | 2007-05-22 |
| 1265657910 | Shanna Dawn Jackson | Counselor | 1900 Century Pl Ne, Ste 200, Atlanta, GA 30345-4307 | 2007-04-16 |
| Street Address |
38271 MOUND RD BLDG B |
| City | STERLING HEIGHTS |
| State | MI |
| Zip Code | 48310-3401 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770126955 | Madison Queener | Case Manager/Care Coordinator | 38271 Mound Rd Bldg B, Sterling Heights, MI 48310-3401 | 2019-10-21 |
| 1952956815 | Ngan Duong | Case Manager/Care Coordinator | 38271 Mound Rd Bldg B, Sterling Heights, MI 48310-3401 | 2019-08-07 |
| 1538643226 | Shakaree Lewis | Case Manager/Care Coordinator | 38271 Mound Rd Bldg B, Sterling Heights, MI 48310-3401 | 2018-09-19 |
| 1801253992 | Lacey Jo Smith | Case Manager/Care Coordinator | 38271 Mound Rd Bldg B, Sterling Heights, MI 48310-3401 | 2016-01-21 |
| 1871989616 | Sax Guthery | Counselor | 38271 Mound Rd Bldg B, Sterling Heights, MI 48310-3401 | 2015-04-08 |
| 1831583087 | Robin Brumlow | Social Worker | 38271 Mound Rd Bldg B, Sterling Heights, MI 48310-3401 | 2015-03-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508476961 | Briana Smiley | Behavior Technician | 34475 Mound Road, Sterling Heights, MI 48310 | 2020-07-31 |
| 1902442262 | Evolve Physical Therapy LLC | Physical Therapist | 35654 Dequindre Rd, Sterling Heights, MI 48310 | 2019-11-21 |
| 1245715291 | Brooksprings Dialysis, LLC | Clinic/Center | 2391 Fifteen Mile Rd, Sterling Heights, MI 48310 | 2018-09-26 |
| 1942784368 | Brittany Lee Anderson | Chiropractor | 34770 Dequindre Rd., Sterling Heights, MI 48310 | 2018-09-21 |
| 1386140572 | Arpan Patel | Nurse Practitioner | 37303 Tericrest Dr, Sterling Heights, MI 48310 | 2018-04-05 |
| 1306340955 | Prestige Specialty Pharmacy LLC | Pharmacy | 3739 15 Mile Rd, Sterling Heights, MI 48310 | 2018-03-20 |
| 1942704663 | Tazul Choudhury | Occupational Therapist | 34643 Ketsin Dr., Therapy Dept., Sterling Heights, MI 48310 | 2018-03-19 |
| 1013410950 | Robert Parent | Physical Therapist | 34643 Ketsin Drive, Sterling Heighs, MI 48310 | 2018-03-16 |
| 1194231563 | Total Orthopedic Performance Physical Therapy, LLC | Physical Therapist | 3522 15 Mile Road, Sterling Heights, MI 48310 | 2017-12-21 |
| 1851807309 | Happy Life 2 Inc | Clinic/Center | 3727 15 Mile Rd, Sterling Heights, MI 48310 | 2017-12-20 |
| Find all providers in zip 48310 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699323337 | Alexandrea Elizabeth Young-rivard | Counselor | 39141 University Dr, Sterling Heights, MI 48310-2776 | 2019-08-27 |
| 1619532835 | Christina Odarka Zurkiwskyj | Counselor | 2230 Oakcrest Rd, Sterling Heights, MI 48310-4278 | 2019-05-02 |
| 1366905408 | Mustard Seed Family Counseling LLC | Counselor | 2311 15 Mile Rd Ste A1, Sterling Heights, MI 48310-4842 | 2019-04-06 |
| 1376084020 | Joy Patricia Creel | Counselor | 43237 Cape Dr, Sterling Heights, MI 48313-2334 | 2017-03-14 |
| 1497153365 | Damon Daniels | Counselor | 13854 Lakeside Cir Ste 255, Suite 255, Sterling Heights, MI 48313-1316 | 2014-12-09 |
| 1831526185 | Henrietta Mcnair-ford | Counselor | 13854 Lakeside Cir Ste 242, Sterling Heights, MI 48313-1316 | 2013-10-02 |
| 1407289341 | Catherine M Saputo | Counselor | 44056 Mound Rd Ste 103, Sterling Heights, MI 48314-1357 | 2013-08-14 |
| 1528310976 | Naimah H Halim | Counselor | 37331 Clubhouse Dr, Sterling Heights, MI 48312-2245 | 2012-10-10 |
| 1689938094 | Jennifer Marie Talbot | Counselor | 43433 Bockley Dr, Sterling Heights, MI 48313-1709 | 2012-06-29 |
| 1780953950 | Elizabeth Kay Pruzinsky | Counselor | 14508 Valusek Dr, Sterling Heights, MI 48312-6668 | 2011-12-17 |
| Find all providers in STERLING HEIGHTS | ||||
| City | STERLING HEIGHTS |
| Zip Code | 48310 |
Please comment or provide details below to improve the information on SHANNA 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.