Healthcare Provider Details

I. General information

NPI: 1356258180
Provider Name (Legal Business Name): THOMASSIA JACKSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 FASSETT ST APT UPPERB
TOLEDO OH
43605-3112
US

IV. Provider business mailing address

222 FASSETT ST APT UPPERB
TOLEDO OH
43605-3112
US

V. Phone/Fax

Practice location:
  • Phone: 419-787-0417
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: