David Jackson, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

21551 Issued in MN

Practice address

220 Railroad St SE
Pine City, MN 55063-1540

Phone

(320) 629-7600

NPI assigned

Dec 22, 2022

Last updated

Dec 22, 2022By the provider in NPPES

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

Enrolled in MN

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

Specialty

Clinical Social Worker

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Therapeutic Services Agency IncGroup PAC ID 4981877891, 14 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Therapeutic Services Agency Inc

  • Marriage & Family Therapist
  • Pine City, MN
  • NPI 1497741607
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1671667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671667200000",
    "number": "1548972425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 RAILROAD ST SE",
            "city": "PINE CITY",
            "state": "MN",
            "postal_code": "550631540",
            "telephone_number": "320-629-7600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 RAILROAD ST SE",
            "city": "PINE CITY",
            "state": "MN",
            "postal_code": "550631540",
            "telephone_number": "320-629-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DAVID",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-12-22",
        "last_updated": "2022-12-22",
        "certification_date": "2022-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "21551",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracie Houle, LPCC
• Nicole Cecelia Hubbs, LMFT
• Annette Veneva Huff, LICSW
• Hultman Lake Enterprises
• Ind School District 578
• Lainie K Janke, LICSW
• Jeff's Outdoor Services
• Jewett Lake Enterprises
• Christine Tande Johnson, PSYD LP
• Erik Robert Johnson, LMFT

• Clinical Social Worker in Pine City, MN
• Providers in Pine City, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2022; 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.