Elizabeth A Jackson, LIC. MASSAGE THERAPI

Primary specialty

SpecialistTaxonomy code 174400000X

License

MT3127 Issued in ME

Practice address

94 Auburn St Ste 106
Portland, ME 04103-2141

Phone

(207) 878-3003

Fax

(207) 878-3004

NPI assigned

Apr 24, 2008

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1208995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228694400000",
    "number": "1104091784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "94 AUBURN ST",
            "address_2": "SUITE 106",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041032141",
            "telephone_number": "207-878-3003",
            "fax_number": "207-878-3004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "94 AUBURN ST STE 106",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041032141",
            "telephone_number": "207-878-3003",
            "fax_number": "207-878-3004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ELIZABETH",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "LIC. MASSAGE THERAPI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-24",
        "last_updated": "2008-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "ME",
            "license": "MT3127",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• McKayla Ivey
• Jessica Rayne Iyer, MB, BCH, BAO
• Sebastian Mark Jablonski, D.O.
• Amity Jackson, LCSW
• David Yarnall Jackson, DO
• Emily Jackson, M.S. CCC-SLP
• Heather M. Jackson, LCSW
• James E Jackson, DMD
• Meredith Bryden Jackson, M.D.
• Ryan Christopher Jackson, MD

• Specialist in Portland, ME
• Providers in Portland, ME by specialty
• Specialist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.