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General NPI Number Information
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NPI Number | 1235428780
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Entity Type | Individual
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Provider Name | JOY A JACKSON LISW-S
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Gender | Female
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Dates
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Enumeration Date | 04/06/2011
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 11801 BUCKEYE RD
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City | CLEVELAND
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State | OH
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Zip | 44120-2620
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Country | US
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Telephone | 216-831-2255
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Fax | 216-378-3906
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Provider Business Mailing Address
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Address Line | 12200 FAIRHILL RD
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City | CLEVELAND
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State | OH
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Zip | 44120-1058
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Country | US
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Telephone | 216-923-0333
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Fax | 216-923-0343
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | S.0901107
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C014568
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 106816
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.1101049
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License Number State | OH
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