Jillian J Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW 11320 Issued in FL

Practice address

436 McKenna Dr
Winter Haven, FL 33881-9743

Phone

(407) 853-9457

Fax

(877) 940-4305

NPI assigned

Jun 11, 2010

Sex

Female

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

Enrolled in FL, CO2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Clinical Social Worker

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Grow Healthcare Group PAGroup PAC ID 3476961368, 1,045 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical, CO

  Medicare reassignment Care Compare group NPD
• Personal Recovery Network LLC

  dba LifeStance Health

  • Psychiatry Physician
  • Stockbridge, GA
  • NPI 1881990869

  FL

  Medicare reassignment NPD
• Grace & Truth Practical Therapy, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Winter Haven, FL
  • NPI 1902515455
  NPD Authorized official

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

{
    "created_epoch": "1276214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698019200000",
    "number": "1457672594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "436 MCKENNA DR",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338819743",
            "telephone_number": "407-853-9457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "436 MCKENNA DR",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338819743",
            "telephone_number": "407-853-9457",
            "fax_number": "877-940-4305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JILLIAN",
        "middle_name": "J",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-11",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW 11320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sherif Isshak Ibrahim, MD
• J. Agustin Lacson M.D. Inc (Lacson MD Community Pharmacy)
• J&Y Assisted Living for the Ages
• Jackson Diagnostic Imaging, Inc
• Daniel Jackson, COTA
• Patrice Jackson
• Sarelyn Bertina Jackson
• Stephanie Kay Jackson
• Jared Jacobs, APRN
• Maria Jaimes-Cid

• Clinical Social Worker in Winter Haven, FL
• Providers in Winter Haven, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.