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NPI Code Detail

MEDICARE: MICHELE JACKSON LMSW

MEDICARE:   MICHELE  JACKSON  LMSW
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
11041C0700XClinical Social WorkerP013052NC
2104100000XSocial Worker64908TX

General Provider Information

NPI Number : 1669031753
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELE JACKSON LMSW
Provider Business Mailing Address
First Line : 2306 VERONA CT
Second Line :
City : HARKER HEIGHTS
State : TX
Zip : 76548-8855
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2306 VERONA CT
Second Line :
City : HARKER HEIGHTS
State : TX
Zip : 76548-8855
Country : US
Telephone Number : 912-572-7273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2019
Last Update Date : 06/11/2019

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Directions to “ MICHELE JACKSON LMSW” Practice Location

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