MEDICARE: MRS. MEGAN ELIZABETH JACKSON MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	124688	IA
2	106H00000X	Marriage & Family Therapist	141393	CA

General Provider Information

NPI Number	:	1629845490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEGAN ELIZABETH JACKSON MS

Provider Business Mailing Address
First Line	:	1633 E 4TH ST STE 120
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-5143
Country	:	US
Telephone Number	:	714-558-9266
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 FRANKLIN AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50322-6131
Country	:	US
Telephone Number	:	515-277-2489
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2023
Last Update Date	:	03/19/2024

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