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NPI Code Detail

MEDICARE: JIA JACKSON

MEDICARE: JIA 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 : 1790610251
Entity Type Code : Individual
Provider Name (Legal Business Name) : JIA JACKSON
Provider Business Mailing Address
First Line : 10440 LITTLE PATUXENT PKWY
Second Line :
City : COLUMBIA
State : MD
Zip : 21044-3561
Country : US
Telephone Number : 410-220-0768
Fax Number :
Provider Business Practice Location Address
First Line : 10440 LITTLE PATUXENT PKWY
Second Line :
City : COLUMBIA
State : MD
Zip : 21044-3561
Country : US
Telephone Number : 410-220-0768
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2026
Last Update Date : 06/16/2026

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