Shawn A Jackson, SAC-IT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

16299-130 Issued in WI

Practice address

10532 N. Port Washington Rd.
Mequon, WI 53092

Phone

(262) 242-3810

Fax

(262) 242-3816

NPI assigned

Dec 13, 2011

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1323734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357862400000",
    "number": "1487922837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10532 N PORT WASHINGTON RD",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925563",
            "telephone_number": "262-242-3810",
            "fax_number": "262-242-3816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10532 N. PORT WASHINGTON RD.",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "53092",
            "telephone_number": "262-242-3810",
            "fax_number": "262-242-3816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHAWN",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "SAC-IT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-12-13",
        "last_updated": "2013-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "16299-130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karolyn M Ivanovic, M.D.
• Christian Izard
• Melissa Irene Izzard, RRT
• Caitlin Rose Jacek, LCSW
• Ostassia Jackson
• Diana R Jacobs, DO
• Marc Jacobson, DDS
• Michaela Jagemann, OTR/L
• Gabriella Janke, PT, DPT
• Jennifer Janowitz, MS, LPC

• Addiction (Substance Use Disorder) Counselor in Mequon, WI
• Providers in Mequon, WI by specialty
• Addiction (Substance Use Disorder) Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2013; 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.