Kim M Jackson, LISW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I2506226 Issued in OH

Practice address

3500 Carnegie Ave
Cleveland, OH 44115-2641

Phone

(440) 260-8554

NPI assigned

Oct 15, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ohioguidestone

  • Developmental - Behavioral Pediatrics Physician
  • Berea, OH
  • NPI 1609123728
  Medicare reassignment NPD
• Ohioguidestone

  • Community/Behavioral Health Agency
  • Berea, OH
  • NPI 1174680557
  NPD
• Ohioguidestone

  • Family Medicine Physician
  • Lorain, OH
  • NPI 1487452603
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758499200000",
    "number": "1003126699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 CARNEGIE AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441152641",
            "telephone_number": "440-260-8554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 CARNEGIE AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441152641",
            "telephone_number": "440-260-8554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KIM",
        "middle_name": "M",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-15",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I2506226",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0268768",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julie Terese Jackson, LSW
• Kadijah C Jackson, RN
• Kalana Latriece Jackson, STNA
• Kathy Joy Jackson, MSSA, LSW
• Ketura L Jackson, RN
• Kimberly Scherie Jackson, RN
• Kristofer Jackson
• Kyawna Charelle Jackson, LPN
• Lalisha Reanee Jackson, MEDICAL ASSISTANT
• Laresa A Jackson

• Clinical Social Worker in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.