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General NPI Number Information
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NPI Number | 1487148557
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Entity Type | Individual
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Provider Name | AISHA MARIE JACKSON SWA
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Gender | Female
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Dates
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Enumeration Date | 06/21/2018
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 3659 GREEN RD STE 220
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City | BEACHWOOD
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State | OH
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Zip | 44122-5715
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Country | US
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Telephone | 216-260-9022
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Fax | 216-260-9038
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Provider Business Mailing Address
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Address Line | 16314 SEVILLE RD
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City | CLEVELAND
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State | OH
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Zip | 44128-3714
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Country | US
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Telephone | 216-318-4553
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | W.1300054
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License Number State | OH
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