Healthcare Provider Details

I. General information

NPI: 1043985930
Provider Name (Legal Business Name): KATHARINE MAEVE JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 ARMSTRONG RD
BATTLE CREEK MI
49037-7314
US

IV. Provider business mailing address

5500 ARMSTRONG RD
BATTLE CREEK MI
49037-7314
US

V. Phone/Fax

Practice location:
  • Phone: 269-966-5600
  • Fax:
Mailing address:
  • Phone: 269-966-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number09162020
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801122957
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: