MR. MATTHEW JACKSON (NPI# 1952794570) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952794570 |
| Entity Type | Individual |
| Full Name | MR. MATTHEW JACKSON |
| Practice Address |
714 N Michigan St South Bend IN 46601-1035 |
| Mailing Address |
710 N Niles Ave South Bend IN 46617-1924 |
| Practice Telephone | 5746477477 |
| Mailing Telephone | 5746471610 |
| Enumeration Date | 2015-03-06 |
| Last Update Date | 2018-09-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103T00000X | Psychologist | Behavioral Health & Social Service Providers | ||
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
20042961A | IN | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 300017159 | 05 | |
| IN | MEDICARE PTAN | 162520066 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184278913 | Matthew Jackson | Student in an Organized Health Care Education/Training Program | 540 W 5150 S, Washington Terrace, UT 84405-6530 | 2019-07-30 |
| 1922651041 | Matthew Jackson | Social Worker | 1820 Pleasant Dr, Portage, MI 49002-5604 | 2019-07-17 |
| 1093289795 | Matthew Kory Jackson | Chiropractor | 515 E 4500 S Ste G230, Salt Lake City, UT 84107-4510 | 2019-01-15 |
| 1932558210 | Matthew Jackson | Driver | 3121 Johnston St Apt 142, Lafayette, LA 70503-3760 | 2016-06-08 |
| 1306237201 | Matthew Jackson | Specialist/Technologist | 51 Edward Rd, Townsend, MA 01469-1107 | 2015-02-12 |
| 1710235452 | Matthew Kane Jackson | Pharmacist | 942 Loy Cemetery Rd, Columbia, KY 42728-8719 | 2012-08-28 |
| 1619103702 | Matthew Matthew Jackson | Case Manager/Care Coordinator | 1101 West Morgan St, Suite 8, Paragould, AR 72450-3949 | 2009-06-03 |
| 1609942531 | Matthew Bryan Jackson | Massage Therapist | 2600 Sw Barton Street, Suite A24, Seattle, WA 98126 | 2006-11-24 |
| 1962481887 | Matthew Dv Jackson | Dentist | 9319 E Harry, #126, Wichita, KS 67207 | 2006-01-10 |
| 1528590460 | Matthew Dean Jackson | Student in an Organized Health Care Education/Training Program | 571 S Floyd St, Ste 412, Louisville, KY 40202-3818 | 2017-03-30 |
| Street Address |
714 N MICHIGAN ST |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46601-1035 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033115852 | Dale Alan Patterson | Family Medicine | 714 N Michigan St, South Bend, IN 46601-1035 | 2005-06-27 |
| 1457972499 | Megan Susanne Spencer | Student in an Organized Health Care Education/Training Program | 714 N Michigan St, South Bend, IN 46601-1035 | 2020-04-30 |
| 1588284079 | Madeline Grace Chandler | Student in an Organized Health Care Education/Training Program | 714 N Michigan St, South Bend, IN 46601-1035 | 2020-04-24 |
| 1255951968 | Kallie Kram | Student in an Organized Health Care Education/Training Program | 714 N Michigan St, South Bend, IN 46601-1035 | 2020-04-22 |
| 1235759069 | Audrieanna Marie Kramer | Student in an Organized Health Care Education/Training Program | 714 N Michigan St, South Bend, IN 46601-1035 | 2020-04-22 |
| 1417577271 | Deborah Michelle Pavey | Student in an Organized Health Care Education/Training Program | 714 N Michigan St, South Bend, IN 46601-1035 | 2020-04-22 |
| 1841810702 | Kaitlin Vanderkolk | Student in an Organized Health Care Education/Training Program | 714 N Michigan St, South Bend, IN 46601-1035 | 2020-04-21 |
| 1982224879 | Allyson Nicole Dimagno | Student in an Organized Health Care Education/Training Program | 714 N Michigan St, South Bend, IN 46601-1035 | 2020-04-21 |
| 1609496686 | Garrett Muhlstadt | Student in an Organized Health Care Education/Training Program | 714 N Michigan St, South Bend, IN 46601-1035 | 2020-04-20 |
| 1033748710 | James Alan Handtke | Student in an Organized Health Care Education/Training Program | 714 N Michigan St, South Bend, IN 46601-1035 | 2020-04-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447610449 | David Thomas | Hearing Instrument Specialist | 808 S Michigan St., South Bend, IN 46601 | 2016-03-03 |
| 1285072454 | Kevin Francis Cumper | Internal Medicine | 621 Memorial Dr Ste 624, South Bend, IN 46601 | 2013-06-11 |
| 1952605560 | Robert Lusk Bonham | Dentist | 1222 L.w.e., So. Bend, IN 46601 | 2010-12-23 |
| 1649580911 | Daniel Scott Debrule | Psychologist | 211 W. Washington Street, Suite 2311, South Bend, IN 46601 | 2010-10-20 |
| 1528390770 | Luke Alfred White | Internal Medicine | 615 N. Michigan St., Memorial Hospital, C/o Erin Smith, South Bend, IN 46601 | 2010-02-12 |
| 1548497837 | Tmg Home Health Care | Home Health | 108 N Main St #305, South Bend, IN 46601 | 2009-06-15 |
| 1225283039 | Jody L. Hughes | Counselor | 202 S. Michigan Street, Suite 875, South Bend, IN 46601 | 2008-11-20 |
| 1740432574 | Amanda Jayne Quicksall | Social Worker | 611 Lincolnway W, South Bend, IN 46601 | 2008-10-10 |
| 1952565772 | Thomas P Judd | Dentist | 1901 #b Western Avenue, Ihc South Bend, South Bend, IN 46601 | 2008-07-10 |
| 1851590269 | Warren Larry Penrod | Nurse Practitioner | 333 W. Western Ave, South Bend, IN 46601 | 2007-07-16 |
| Find all providers in zip 46601 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346697000 | Alexandra Filia Corning | Psychologist | 1251 N. Eddy Street, Suite 200, South Bend, IN 46530-6258 | 2016-05-23 |
| 1629222088 | Suzanne Courtney | Psychologist | 129 Franklin Pl, South Bend, IN 46601-1543 | 2008-11-12 |
| 1518111996 | Jacqueline Mary Quinn-tan | Psychologist | 1000 S Michigan St, South Bend, IN 46601-3426 | 2008-11-11 |
| 1942487483 | David A Smith | Psychologist | 1251 N Eddy St Ste 200, South Bend, IN 46617-1478 | 2008-01-28 |
| 1972727949 | Susan Steibe-pasalich | Psychologist | 201 N Ironwood Dr, South Bend, IN 46615-2517 | 2007-04-12 |
| 1952452534 | Diane Johnson Prosser | Psychologist | 227 N Dixie Way Ste 110, South Bend, IN 46637-3366 | 2007-01-12 |
| 1053476697 | Barbara S Searle | Psychologist | 3603 E Jefferson Blvd, Suiteb, South Bend, IN 46615-3035 | 2006-12-26 |
| 1629144043 | Michael Owen Reed | Psychologist | 220 W Colfax Ave, Ste 400, South Bend, IN 46601-1635 | 2006-11-28 |
| 1902984958 | James F Brogle | Psychologist | 828 E Colfax Ave, South Bend, IN 46617-2804 | 2006-11-01 |
| 1518055565 | Michael Robert Sheehan | Psychologist | 1230 Hillcrest Rd, South Bend, IN 46617-1169 | 2006-10-11 |
| Find all providers in SOUTH BEND | ||||
| City | SOUTH BEND |
| Zip Code | 46601 |
Please comment or provide details below to improve the information on MR. MATTHEW 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.