Healthcare Provider Details

I. General information

NPI: 1295669281
Provider Name (Legal Business Name): ACUITY BRAIN HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 CLEVELAND AVE S
SAINT PAUL MN
55116-1218
US

IV. Provider business mailing address

670 CLEVELAND AVE S
SAINT PAUL MN
55116-1218
US

V. Phone/Fax

Practice location:
  • Phone: 404-849-4855
  • Fax: 651-858-5964
Mailing address:
  • Phone: 404-849-4855
  • Fax: 651-858-5964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JACKIE L MICKLEWRIGHT
Title or Position: BOARD CERTIFIED NEUROPSYCHOLOGIST
Credential: PHD, LP, ABPP-CN
Phone: 404-849-4855