Active NPI
Stacy Ann Jackson, N/A
- Behavior Analyst
- Salem, OR
National Provider Identifier
1376012609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 3762 Amber St NE Apt 102
Salem, OR 97301-6883 - Phone
- (971) 239-2390
- NPI assigned
- Nov 15, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | Primary |
Addresses
Primary practice location
3762 Amber St NE Apt 102
Salem, OR 97301-6883
Mailing address
3400 State St Ste 750
Salem, OR 97301-5861
Phone (971) 273-7502
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1542240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542240000000",
"number": "1376012609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3400 STATE ST STE 750",
"city": "SALEM",
"state": "OR",
"postal_code": "973015861",
"telephone_number": "971-273-7502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3762 AMBER ST NE APT 102",
"city": "SALEM",
"state": "OR",
"postal_code": "973016883",
"telephone_number": "971-239-2390"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "STACY",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "N/A",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-11-15",
"last_updated": "2018-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.