Jackson Adonis Grey

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

1294 18TH St E
Hastings, MN 55033-3680

Phone

(651) 888-4462

NPI assigned

Oct 19, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1666137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666137600000",
    "number": "1508582727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1294 18TH ST E",
            "city": "HASTINGS",
            "state": "MN",
            "postal_code": "550333680",
            "telephone_number": "651-888-4462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1294 18TH ST E",
            "city": "HASTINGS",
            "state": "MN",
            "postal_code": "550333680",
            "telephone_number": "651-888-4462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREY",
        "first_name": "JACKSON",
        "middle_name": "ADONIS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-10-19",
        "last_updated": "2022-10-19",
        "certification_date": "2022-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jackson.grey@detoxone.org",
            "affiliation": "N",
            "address_1": "1294 18th St E",
            "city": "Hastings",
            "state": "MN",
            "country_code": "US",
            "postal_code": "550333680",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Patricia Dorothy Gosz, LICSW
• Grand St Paul CVS LLC
• Rebecca C Grandstrand, CNP
• Julie Marie-Courts Greunke
• Kristin Grew, MAAC-AP, LADC
• Dana Gunderson, DDS
• Hunter Hager, MA, LADC
• Renee Dawn Haliburton, PT
• Han Hastings, LLC
• Linda K Hansen, M.A., L.P.

• Addiction (Substance Use Disorder) Counselor in Hastings, MN
• Providers in Hastings, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2022; 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.