MEDICARE: JOSEPH JACKSON 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
1	171M00000X	Case Manager/Care Coordinator		TX

General Provider Information

NPI Number	:	1023968906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH JACKSON MSW

Provider Business Mailing Address
First Line	:	11070 KATY FWY APT 1456
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-4794
Country	:	US
Telephone Number	:	832-571-5951
Fax Number	:

Provider Business Practice Location Address
First Line	:	11070 KATY FWY APT 1456
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-4794
Country	:	US
Telephone Number	:	832-571-5951
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2026
Last Update Date	:	01/30/2026

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