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NPI Code Detail

MEDICARE: SHANNON JACKSON

MEDICARE: SHANNON 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1639806193
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON JACKSON
Provider Business Mailing Address
First Line : 2743 SMITH RANCH RD STE 704
Second Line :
City : PEARLAND
State : TX
Zip : 77584-5218
Country : US
Telephone Number : 281-215-3985
Fax Number :
Provider Business Practice Location Address
First Line : 2743 SMITH RANCH RD STE 704
Second Line :
City : PEARLAND
State : TX
Zip : 77584-5218
Country : US
Telephone Number : 281-215-3985
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2022
Last Update Date : 12/26/2024

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Directions to “ SHANNON JACKSON ” Practice Location

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