MEDICARE: DR. SHERLEEN HARRIS JACKSON MSW, PH.D.

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

General Provider Information

NPI Number	:	1801127741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHERLEEN HARRIS JACKSON MSW, PH.D.

Provider Business Mailing Address
First Line	:	2220 N CLASSEN BLVD
Second Line	:	SUITE E
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-5809
Country	:	US
Telephone Number	:	405-528-1748
Fax Number	:	405-528-1802

Provider Business Practice Location Address
First Line	:	2220 N CLASSEN BLVD
Second Line	:	SUITE E
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-5809
Country	:	US
Telephone Number	:	405-528-1748
Fax Number	:	405-528-1802

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

Provider Enumeration Date	:	01/15/2010
Last Update Date	:	01/15/2010

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