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NPI Code Detail

MEDICARE: MS. VICTORIA CASSANDRA JACKSON LCSW

MEDICARE: MS. VICTORIA CASSANDRA 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
11041C0700XClinical Social Worker9244WI

General Provider Information

NPI Number : 1679984108
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. VICTORIA CASSANDRA JACKSON LCSW
Provider Business Mailing Address
First Line : 4800 N SCOTTSDALE RD STE 2500
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85251-7630
Country : US
Telephone Number : 262-999-3495
Fax Number :
Provider Business Practice Location Address
First Line : 10850 W PARK PL STE 100
Second Line :
City : MILWAUKEE
State : WI
Zip : 53224-3636
Country : US
Telephone Number : 262-999-3495
Fax Number : 262-821-6180
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2014
Last Update Date : 03/10/2026

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Directions to “ MS. VICTORIA CASSANDRA JACKSON LCSW” Practice Location

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