Active NPI
Susan M. Jackson-Walker, PHD
- Clinical Child & Adolescent Psychologist
- Wilmington, DE
National Provider Identifier
1124110911
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- B10000648
- Practice address
- A.I. Dupont Hospital for Children
1600 Rockland Road
Wilmington, DE 19803-3607 - Phone
- (302) 651-4000
- Fax
- (302) 651-4945
- NPI assigned
- Sep 29, 2006
- Last updated
- May 16, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | B10000648 | DE | Primary |
| Developmental - Behavioral Pediatrics Physician | 2080P0006X | B10000648 | DE |
Addresses
Primary practice location
A.I. Dupont Hospital for Children
1600 Rockland Road
Wilmington, DE 19803-3607
Mailing address
Nemours Childrens Clinic
P.O. Box 404112
Atlanta, GA 30384-0001
Phone (904) 390-3610
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5119049 | Medicaid | MD | |
| 8919704 | Medicaid | NJ | |
| 1913085 | Medicaid | PA |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| B10000648 | DE | MD | Developmental - Behavioral Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210896000000",
"number": "1124110911",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "NEMOURS CHILDRENS CLINIC",
"address_2": "P.O. BOX 404112",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303840001",
"telephone_number": "904-390-3610",
"fax_number": "904-288-5890"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "A.I. DUPONT HOSPITAL FOR CHILDREN",
"address_2": "1600 ROCKLAND ROAD",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198033607",
"telephone_number": "302-651-4000",
"fax_number": "302-651-4945"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON-WALKER",
"first_name": "SUSAN",
"middle_name": "M.",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-29",
"last_updated": "2008-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "DE",
"license": "B10000648",
"primary": true
},
{
"code": "2080P0006X",
"taxonomy_group": "",
"desc": "Pediatrics, Developmental - Behavioral Pediatrics",
"state": "DE",
"license": "B10000648",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5119049",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8919704",
"state": "NJ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1913085",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 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.