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NPI Code Detail

MEDICARE: MS. CHRISTINE M. JACKSON MSW

MEDICARE: MS. CHRISTINE M. 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
11041C0700XClinical Social WorkerLC303202DC

General Provider Information

NPI Number : 1104963560
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHRISTINE M. JACKSON MSW
Provider Business Mailing Address
First Line : 5112 CONNECTICUT AVE NW
Second Line : APT. 212
City : WASHINGTON
State : DC
Zip : 20008-2065
Country : US
Telephone Number : 202-966-1130
Fax Number :
Provider Business Practice Location Address
First Line : 2607 CONNECTICUT AVE NW
Second Line : WTG
City : WASHINGTON
State : DC
Zip : 20008-1522
Country : US
Telephone Number : 202-293-8296
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2007
Last Update Date : 07/08/2007

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