Active NPI
Destiny Jackson, HAS
- Social Worker
- Cleveland, OH
National Provider Identifier
1255942157
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- S.2411200
- Practice address
- 3518 W 25TH St
Cleveland, OH 44109-1951 - Phone
- (216) 741-2241
- Fax
- (216) 459-9821
- NPI assigned
- Aug 13, 2020
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 23003122 | OH | |
| Case Manager/Care Coordinator | 171M00000X | |||
| Hearing Instrument Specialist | 237700000X | IL.03403 | OH | |
| Social Worker | 104100000X | S.2411200 | OH | Primary |
Addresses
Primary practice location
3518 W 25TH St
Cleveland, OH 44109-1951
Mailing address
3518 W 25TH St
Cleveland, OH 44109-1995
Phone (216) 741-2241
Other practice location 1
11635 Euclid Ave
Cleveland, OH 44106-4319
Phone (216) 231-8787
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0325500 | Medicaid | OH |
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 |
|---|---|---|---|
| S.2411200 | OH | MD | Social Worker |
| 23003122 | OH | MD | Clinical Social Worker |
| IL.03403 | OH | MD | Hearing Instrument Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724630400000",
"number": "1255942157",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3518 W 25TH ST",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441091995",
"telephone_number": "216-741-2241",
"fax_number": "216-459-9821"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3518 W 25TH ST",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441091951",
"telephone_number": "216-741-2241",
"fax_number": "216-459-9821"
}
],
"practiceLocations": [
{
"address_1": "11635 Euclid Ave",
"address_purpose": "LOCATION",
"city": "Cleveland",
"state": "OH",
"postal_code": "441064319",
"country_code": "US",
"telephone_number": "216-231-8787",
"fax_number": "216-231-7141",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "DESTINY",
"credential": "HAS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-13",
"last_updated": "2024-08-26",
"certification_date": "2024-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OH",
"license": "23003122",
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "237700000X",
"taxonomy_group": "",
"desc": "Hearing Instrument Specialist",
"state": "OH",
"license": "IL.03403",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "S.2411200",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0325500",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.