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1457740821 NPI number — BRIANNE AR JACKSON LCSW

NPI Number: 1457740821
Health Care Provider/Practitioner: BRIANNE AR JACKSON LCSW

Information about “1457740821” NPI (BRIANNE AR JACKSON LCSW) exists in 1457740821 in HTML format HTML  |  1457740821 in plain Text format TXT  |  1457740821 in PDF (Portable Document Format) PDF  |  1457740821 in an XML format XML  formats.

NPI Number : 1457740821 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1457740821",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JACKSON",
    "FirstName": "BRIANNE",
    "MiddleName": "AR",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ROBSON",
    "OtherFirstName": "BRIANNE",
    "OtherMiddleName": "A",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LCSW",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "114 MEADOWS CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BOURBONNAIS",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60914-1120",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "815-641-9630",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1880 N STATE ROUTE 50 # C",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BOURBONNAIS",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60914-4432",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "815-641-9630",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/22/2015",
    "LastUpdateDate": "01/01/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "149.019017",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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