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General NPI Number Information
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NPI Number | 1982769642
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Entity Type | Individual
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Provider Name | SHERIDAN ANN JACKSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/23/2006
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 2505 CRATER ROCK ST
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City | HENDERSON
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State | NV
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Zip | 89044-1598
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Country | US
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Telephone | 678-640-5723
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Fax | 818-224-7571
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Provider Business Mailing Address
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Address Line | 2505 CRATER ROCK ST
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City | HENDERSON
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State | NV
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Zip | 89044-1598
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Country | US
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Telephone | 678-640-5723
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Fax | 818-224-7571
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCSW110384
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License Number State | CA
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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 | CSW003684
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 12049-C
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License Number State | NV
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