Elyshua Renee Jackson, LISW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.2405083 Issued in OH

Practice address

1550 Old Henderson Rd Ste N-271
Columbus, OH 43220-3626

Phone

(614) 456-7334

NPI assigned

Apr 9, 2024

Sex

Female

Sole proprietor

No

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 OH

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 1

Medicare enrollment (NPD)

Enrolled

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, OH

  Medicare reassignment NPD

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

{
    "created_epoch": "1712620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735776000000",
    "number": "1477306454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3053 E HUDSON ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432191632",
            "telephone_number": "614-537-2240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 OLD HENDERSON RD STE N-271",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432203626",
            "telephone_number": "614-456-7334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ELYSHUA",
        "middle_name": "RENEE",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-09",
        "last_updated": "2025-01-02",
        "certification_date": "2025-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.2405083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dominique Terence Jackson, NURSE PRACTITIONER
• Eddie Jackson
• Edna Jackson
• Elaina N Jackson
• Elizabeth Irene Jackson, M.D.
• Felicia Athens Jackson, PH.D., MCJ, RN
• Francesca Jackson, OTR/L
• Fredriona Marie Jackson, STNA
• Haley Jackson
• Heather D. Jackson, PA-C

• Clinical Social Worker in Columbus, OH
• Providers in Columbus, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.