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NPI Code Detail

MEDICARE: DESSIE JACKSON

MEDICARE: DESSIE JACKSON
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
1103K00000XBehavior Analyst95000968AIN

General Provider Information

NPI Number : 1194481622
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESSIE JACKSON
Provider Business Mailing Address
First Line : 1950 DOCTORS PARK DR
Second Line :
City : COLUMBUS
State : IN
Zip : 47203-2375
Country : US
Telephone Number : 812-373-6103
Fax Number :
Provider Business Practice Location Address
First Line : 1950 DOCTORS PARK DR
Second Line :
City : COLUMBUS
State : IN
Zip : 47203-2375
Country : US
Telephone Number : 812-373-6103
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2021
Last Update Date : 02/17/2026

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