Active NPI
Danita A Jackson, LPC-IT
- Mental Health Counselor
- Wauwatosa, WI
National Provider Identifier
1356774723
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 1854-226
- Practice address
- 10045 W Lisbon Ave
Wauwatosa, WI 53222-2446 - Phone
- (414) 358-7999
- Fax
- (414) 358-7158
- NPI assigned
- Aug 20, 2013
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 1854-226 | WI | Primary |
Addresses
Primary practice location
10045 W Lisbon Ave
Wauwatosa, WI 53222-2446
Mailing address
10045 W Lisbon Ave
Wauwatosa, WI 53222-2446
Phone (414) 358-7999
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 |
|---|---|---|---|
| 1854-226 | WI | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395446400000",
"number": "1356774723",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10045 W LISBON AVE",
"city": "WAUWATOSA",
"state": "WI",
"postal_code": "532222446",
"telephone_number": "414-358-7999",
"fax_number": "414-358-7158"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10045 W LISBON AVE",
"city": "WAUWATOSA",
"state": "WI",
"postal_code": "532222446",
"telephone_number": "414-358-7999",
"fax_number": "414-358-7158"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DANITA",
"middle_name": "A",
"credential": "LPC-IT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-08-20",
"last_updated": "2014-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WI",
"license": "1854-226",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wauwatosa, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.