Kassandra Lynn Jackson, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6801093643 Issued in MI

Practice address

17940 Farmington Rd
Livonia, MI 48152-4444

Phone

(517) 234-3627

NPI assigned

Jul 30, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

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.

• Simply Mindful Counseling, LLC

  • Clinical Social Worker
  • Plymouth, MI
  • NPI 1851900302
  Medicare reassignment NPD
• Iha Health Services Corporation

  • Obstetrics & Gynecology Physician
  • Ann Arbor, MI
  • NPI 1235286840
  NPD (past)
• Richard Kneip, PH.D., P.C.

  • Community/Behavioral Health Agency
  • Clarkston, MI
  • NPI 1679739700
  NPD (past)

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

{
    "created_epoch": "1343606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717977600000",
    "number": "1083960942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5420 PROVINCIAL DR",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483022539",
            "telephone_number": "248-830-7782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17940 FARMINGTON RD",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481524444",
            "telephone_number": "517-234-3627"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4200 Whitehall Dr Ste 330",
            "address_purpose": "LOCATION",
            "city": "Ann Arbor",
            "state": "MI",
            "postal_code": "48105",
            "country_code": "US",
            "telephone_number": "734-434-0477",
            "fax_number": "734-434-6240",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18316 Middlebelt Rd",
            "address_purpose": "LOCATION",
            "city": "Livonia",
            "state": "MI",
            "postal_code": "481525007",
            "country_code": "US",
            "telephone_number": "248-615-9730 x4865",
            "fax_number": "248-615-1260",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KASSANDRA",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-30",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801093643",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801093643",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cathyann Jackson, CRNA
• Christopher John Jackson, AGACNP
• Daisah Jackson
• Deana Jackson
• Heather Jackson
• Mykerra Brieanna Jackson I
• Nicole Vanessa Jackson, LMSW
• Paul Jackson, D.O.
• Shantele Dennene Jackson
• Stephanie Jackson, LBSW, QMHP, QIDP

• Social Worker in Livonia, MI
• Providers in Livonia, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; 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.