Healthcare Provider Details

I. General information

NPI: 1184550774
Provider Name (Legal Business Name): DAWN MARIE JACKSON-SHORT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

868 N WASHINGTON ST
POTTSTOWN PA
19464-4339
US

IV. Provider business mailing address

868 N WASHINGTON ST
POTTSTOWN PA
19464-4339
US

V. Phone/Fax

Practice location:
  • Phone: 484-437-6544
  • Fax:
Mailing address:
  • Phone: 484-437-6544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: