Marilyn Sledge Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2160C Issued in AL

Practice address

2325 Briar Gate Dr
Montgomery, AL 36116-2154

Phone

(334) 215-1048

NPI assigned

Nov 6, 2010

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1289001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289001600000",
    "number": "1407157407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2325 BRIAR GATE DR",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361162154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2325 BRIAR GATE DR",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361162154",
            "telephone_number": "334-215-1048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARILYN",
        "middle_name": "SLEDGE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-11-06",
        "last_updated": "2010-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AL",
            "license": "2160C",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW003706",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "5411455-3501",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keith Jackson, PHD
• Labrina F Jackson, ATC, LAT
• Latoya Jackson
• Laura Gail Jackson, ALC
• Lydia Lane Jackson, PA C
• Megan Jackson
• Melinda Louise Jackson, CRNP
• Nakisa J Jackson
• Renita L Jackson
• Sheila Jackson

• Clinical Social Worker in Montgomery, AL
• Providers in Montgomery, AL by specialty
• Clinical Social Worker in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2010; 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.