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NPI Code Detail

MEDICARE: SHAWAN JACKSON RSW, MSW

MEDICARE: SHAWAN JACKSON RSW, MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1023422631
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAWAN JACKSON RSW, MSW
Provider Business Mailing Address
First Line : 1538 LOUISIANA AVE
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70115-3553
Country : US
Telephone Number : 504-896-2345
Fax Number : 504-896-2240
Provider Business Practice Location Address
First Line : 1538 LOUISIANA AVE
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70115-3553
Country : US
Telephone Number : 504-896-2345
Fax Number : 504-896-2240
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2014
Last Update Date : 10/14/2015

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Directions to “ SHAWAN JACKSON RSW, MSW” Practice Location

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