MEDICARE: CASSIE THACKER JACKSON MASTER OF EDUCATION

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1376261602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIE THACKER JACKSON MASTER OF EDUCATION

Provider Business Mailing Address
First Line	:	4987 MURPHY DOME RD
Second Line	:
City	:	FAIRBANKS
State	:	AK
Zip	:	99709-5974
Country	:	US
Telephone Number	:	907-888-2082
Fax Number	:

Provider Business Practice Location Address
First Line	:	4987 MURPHY DOME RD
Second Line	:
City	:	FAIRBANKS
State	:	AK
Zip	:	99709-5974
Country	:	US
Telephone Number	:	907-888-2082
Fax Number	:

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

Provider Enumeration Date	:	08/22/2022
Last Update Date	:	03/04/2026

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