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NPI Code Detail

MEDICARE: MR. SEDRICK WALES JACKSON

MEDICARE: MR. SEDRICK WALES JACKSON
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
11041C0700XClinical Social Worker41529TX

General Provider Information

NPI Number : 1811443039
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SEDRICK WALES JACKSON
Provider Business Mailing Address
First Line : 2000 EAST LAMAR BLVD SUITE 600
Second Line :
City : ARLINGTON
State : TX
Zip : 76006-7361
Country : US
Telephone Number : 214-519-9473
Fax Number : 972-236-0057
Provider Business Practice Location Address
First Line : 2000 EAST LAMAR BLVD SUITE 600
Second Line :
City : ARLINGTON
State : TX
Zip : 76006-7361
Country : US
Telephone Number : 214-519-9473
Fax Number : 972-236-0057
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2016
Last Update Date : 08/28/2016

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Directions to “ MR. SEDRICK WALES JACKSON ” Practice Location

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