Healthcare Provider Details

I. General information

NPI: 1659174555
Provider Name (Legal Business Name): SHARON DENISE JACKSON-GEORGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2291 SHELDON ST
LINCOLN NE
68503-1651
US

IV. Provider business mailing address

2291 SHELDON ST
LINCOLN NE
68503-1651
US

V. Phone/Fax

Practice location:
  • Phone: 432-349-9250
  • Fax:
Mailing address:
  • Phone: 402-349-9250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: