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General NPI Number Information
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NPI Number | 1194342436
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Entity Type | Individual
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Provider Name | SARA JACKSON LSCSW
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Gender | Female
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Dates
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Enumeration Date | 07/02/2020
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 4810 STATE AVE
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City | KANSAS CITY
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State | KS
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Zip | 66102-1748
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Country | US
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Telephone | 816-221-0305
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Fax | 816-221-9121
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Provider Business Mailing Address
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Address Line | 7129 PENNSYLVANIA AVE
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City | KANSAS CITY
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State | MO
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Zip | 64114
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Country | US
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Telephone | 816-589-8719
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCAC00802
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License Number State | KS
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