Rebecca Candland Jacklin, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

68978 Issued in TX

Practice address

633 E Fernhurst Dr Ste 304
Katy, TX 77450-1586

Phone

(817) 753-0022

NPI assigned

May 25, 2021

Last updated

May 25, 2021By the provider in NPPES

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jun 10, 2025 through Jun 10, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1621900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621900800000",
    "number": "1235704990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16019 DIANA LN",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770624406",
            "telephone_number": "832-549-9444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 E FERNHURST DR STE 304",
            "city": "KATY",
            "state": "TX",
            "postal_code": "774501586",
            "telephone_number": "817-753-0022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKLIN",
        "first_name": "REBECCA",
        "middle_name": "CANDLAND",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-25",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "68978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.impireum.com",
            "affiliation": "N",
            "address_1": "633 E Fernhurst Dr Ste 304",
            "city": "Katy",
            "state": "TX",
            "country_code": "US",
            "postal_code": "774501586",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• April Jackson, MS CCC-SLP
• Blessing Jackson
• Brooke Lynn Jackson
• Cecilia Jackson

• Clinical Social Worker in Katy, TX
• Providers in Katy, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.