Vada Jackson, LISW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I 1502383 Issued in OH

Practice address

11156 Canal Rd
Sharonville, OH 45241-5815

Phone

(513) 772-6626

NPI assigned

Mar 22, 2016

Last updated

Mar 22, 2016By the provider in NPPES

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1458604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458604800000",
    "number": "1356703029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1840 FAIRFAX AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452071812",
            "telephone_number": "513-772-6166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11156 CANAL RD",
            "city": "SHARONVILLE",
            "state": "OH",
            "postal_code": "452415815",
            "telephone_number": "513-772-6626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "VADA",
        "credential": "LISW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-03-22",
        "last_updated": "2016-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I 1502383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Hennessy
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• Home Well Senior Care LLC
• Nicole Eileen Ivory, M.ED., BCBA
• Cindy E Jimenez de Cabrera, CNP
• Hannah Kaminsky, LPC
• Kansagra Dentists of Sharonville PC, Inc (Dentists of Sharonville)
• Derek Kenneth Ketchum, DC
• Megan Kopack, MA, LPCC, LPC

• Clinical Social Worker in Sharonville, OH
• Providers in Sharonville, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.