Active NPI
Hailey Jackson, MS
- Professional Counselor
- Riverside, CA
National Provider Identifier
1376145425
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 8794
- Practice address
- 2900 Adams St Ste A410
Riverside, CA 92504-8306 - Phone
- (951) 351-4418
- NPI assigned
- Nov 13, 2020
- Last updated
- Nov 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 8794 | CA | Primary |
Addresses
Primary practice location
2900 Adams St Ste A410
Riverside, CA 92504-8306
Mailing address
2900 Adams St Ste A410
Riverside, CA 92504-8306
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8794 | CA | MD | Speech-Language Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605225600000",
"number": "1376145425",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2900 ADAMS ST STE A410",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925048306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2900 ADAMS ST STE A410",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925048306",
"telephone_number": "951-351-4418"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "HAILEY",
"credential": "MS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-11-13",
"last_updated": "2020-11-13",
"certification_date": "2020-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CA",
"license": "8794",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.