Aisha Marie Jackson, SWA

Primary specialty

Social WorkerTaxonomy code 104100000X

License

W.1300054 Issued in OH

Practice address

3659 Green Rd Ste 220
Beachwood, OH 44122-5715

Phone

(216) 260-9022

Fax

(216) 260-9038

NPI assigned

Jun 21, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Right Direction Behavioral Services

  • Community/Behavioral Health Agency
  • Beachwood, OH
  • NPI 1205446754
  NPD

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

{
    "created_epoch": "1529539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1487148557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16314 SEVILLE RD",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441283714",
            "telephone_number": "216-318-4553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3659 GREEN RD STE 220",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441225715",
            "telephone_number": "216-260-9022",
            "fax_number": "216-260-9038"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "27801 Euclid Ave Ste 600",
            "address_purpose": "LOCATION",
            "city": "Euclid",
            "state": "OH",
            "postal_code": "441323548",
            "country_code": "US",
            "telephone_number": "216-337-1411",
            "fax_number": "216-223-8938",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "AISHA",
        "middle_name": "MARIE",
        "name_prefix": "Miss",
        "credential": "SWA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-21",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "W.1300054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Marie Ivancic, LISW-S
• Izzeldin Izheman
• Jack J. Lesyk, PH.D., Inc.
• Jack Rzepka, M.D., Inc.
• Shawna Jackson Young, LCDC III, LISW
• Arvesha Jackson, MSW, LISW
• Brandon Jackson
• Katherine Jackson, PH.D., ATR-BC
• O'Sha D Jackson
• Stephanie Jackson, OCPRS

• Social Worker in Beachwood, OH
• Providers in Beachwood, OH by specialty
• Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; 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.