Active NPI
T Theresa Jackson, MT-BC
- Music Therapist
- Roseville, CA
National Provider Identifier
1104258615
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Music Therapist
- License
- 08720
- Practice address
- 1412 Oak Grove Dr
Roseville, CA 95747-7352 - Phone
- (916) 782-3467
- NPI assigned
- Aug 7, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Music Therapist | 225A00000X | 08720 | CA | Primary |
Addresses
Primary practice location
1412 Oak Grove Dr
Roseville, CA 95747-7352
Mailing address
1412 Oak Grove Dr
Roseville, CA 95747-7352
Phone (916) 782-3467
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08720 | CA | MD | Music Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375833600000",
"number": "1104258615",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1412 OAK GROVE DR",
"city": "ROSEVILLE",
"state": "CA",
"postal_code": "957477352",
"telephone_number": "916-782-3467"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1412 OAK GROVE DR",
"city": "ROSEVILLE",
"state": "CA",
"postal_code": "957477352",
"telephone_number": "916-782-3467"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "T",
"middle_name": "THERESA",
"credential": "MT-BC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-08-07",
"last_updated": "2013-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "225A00000X",
"taxonomy_group": "",
"desc": "Music Therapist",
"state": "CA",
"license": "08720",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roseville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.