MEDICARE: MS. CINDY SHELLY ANN JACKSON LCSW

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	1041C0700X	Clinical Social Worker	5580-C	NV

General Provider Information

NPI Number	:	1588922553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CINDY SHELLY ANN JACKSON LCSW

Provider Business Mailing Address
First Line	:	732 S 6TH ST # 4942
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6948
Country	:	US
Telephone Number	:	702-268-9977
Fax Number	:	702-776-7750

Provider Business Practice Location Address
First Line	:	732 S 6TH ST # 4942
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6948
Country	:	US
Telephone Number	:	702-268-9977
Fax Number	:	702-776-7750

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

Provider Enumeration Date	:	04/27/2012
Last Update Date	:	05/08/2025

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