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NPI Code Detail

MEDICARE: MS. NIKOL LEIGH JACKSON LSW

MEDICARE: MS. NIKOL LEIGH JACKSON LSW
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
1101YP2500XProfessional CounselorSW013684LPA
2103K00000XBehavior Analyst
3104100000XSocial WorkerSW-013684LPA

General Provider Information

NPI Number : 1508898578
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NIKOL LEIGH JACKSON LSW
Provider Business Mailing Address
First Line : 200 N 7TH STREET
Second Line :
City : LEBANON
State : PA
Zip : 17046-5040
Country : US
Telephone Number : 717-273-1710
Fax Number : 717-273-1416
Provider Business Practice Location Address
First Line : 1733 PENN AVENUE
Second Line :
City : READING
State : PA
Zip : 19609-2054
Country : US
Telephone Number : 610-670-9923
Fax Number : 610-670-2587
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2006
Last Update Date : 05/07/2009

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Directions to “ MS. NIKOL LEIGH JACKSON LSW” Practice Location

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