Shereka M Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

254269 Issued in KY

Practice address

914 E Broadway
Louisville, KY 40204-1037

Phone

(502) 589-5878

Fax

(502) 589-8758

NPI assigned

Jul 5, 2019

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

Enrolled in KY

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

State licenses

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.

• Seven Counties Services, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Louisville, KY
  • NPI 1598793671
  Medicare reassignment

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

{
    "created_epoch": "1562284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661472000000",
    "number": "1205498748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1949 GOLDSMITH LN STE 103",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402183096",
            "telephone_number": "502-296-4657",
            "fax_number": "502-785-4003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 E BROADWAY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402041037",
            "telephone_number": "502-589-5878",
            "fax_number": "502-589-8758"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1949 Goldsmith Ln Ste 103",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402183096",
            "country_code": "US",
            "telephone_number": "502-296-4657",
            "fax_number": "502-785-4003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHEREKA",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-05",
        "last_updated": "2022-08-26",
        "certification_date": "2022-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "254269",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick Dior Jackson
• Sameera Chowdhury Jackson, LPCA
• Sarah E Jackson, M.A.
• Shaniya Jackson, RBT
• Shelita Renee Jackson
• Susan Dee Jackson, M.D.
• Tara Jackson
• Tyrza Nicole Jackson, BS, RBT
• Gabrielle Bella Oropilla Jacob, MD
• Kevin Jacob, BS

• Clinical Social Worker in Louisville, KY
• Providers in Louisville, KY by specialty
• Clinical Social Worker in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 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.