Shasa Jackson, LCSW, DBH

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-20522 Issued in AZ

Practice address

950 E Van Buren St
Avondale, AZ 85323-1506

Phone

(623) 344-6860

Fax

(602) 655-9682

NPI assigned

Jul 7, 2022

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

Medicare fee-for-service enrollment

Enrolled in AZ

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

Practice roles

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

• Maricopa County Special Health Care District

  dba Valleywise Health

  • General Acute Care Hospital
  • Phoenix, AZ
  • NPI 1073576740
  Medicare reassignment
• Maricopa County Special Health Care District

  dba Maricopa Integrated Health

  • Federally Qualified Health Center (FQHC)
  • Phoenix, AZ
  • NPI 1629497474
  NPD (past)

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

{
    "created_epoch": "1657152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657152000000",
    "number": "1013640036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2619 E. ROOSEVELT",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 E VAN BUREN ST",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853231506",
            "telephone_number": "623-344-6860",
            "fax_number": "602-655-9682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHASA",
        "name_prefix": "Dr.",
        "credential": "LCSW, DBH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-07",
        "last_updated": "2022-07-07",
        "certification_date": "2022-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "LCSW-20522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Craig Alan Jackson
• Gates Jackson
• Katherine Jackson
• Kiara Jackson
• Melvin Jackson
• Heather Suzanna Jacobs, RN, MPH, MSN, CPNP
• Trudy Jacobs
• Amaris Shanelle James
• Ketura James
• Kobe M Jamison, BA, RBT

• Clinical Social Worker in Avondale, AZ
• Providers in Avondale, AZ by specialty
• Clinical Social Worker in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2022; 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.