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General NPI Number Information
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NPI Number | 1811282247
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Entity Type | Individual
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Provider Name | JAMES ALLEN JACKSON M.S.W.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2011
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Last Update Date | 05/18/2019
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Provider Practice Location Address
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Address Line | 5209 POINT FOSDICK DR NW STE 205
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City | GIG HARBOR
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State | WA
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Zip | 98335
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Country | US
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Telephone | 253-495-9311
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Fax |
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Provider Business Mailing Address
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Address Line | 5209 POINT FOSDICK DR NW STE 205
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City | GIG HARBOR
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State | WA
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Zip | 98335-1728
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Country | US
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Telephone | 253-495-9311
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Fax | 253-697-3730
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW00004709
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License Number State | WA
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