Active NPI
Evelyn Rosie Jackson
- Licensed Psychiatric Technician
- Redwood City, CA
National Provider Identifier
1609535756
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Psychiatric Technician
- License
- 29981
- Practice address
- 240 Edmonds Rd
Redwood City, CA 94062-3813 - Phone
- (650) 209-1100
- NPI assigned
- Dec 15, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Psychiatric Technician | 167G00000X | 29981 | CA | Primary |
Addresses
Primary practice location
240 Edmonds Rd
Redwood City, CA 94062-3813
Mailing address
240 Edmonds Rd BLDG D
Redwood City, CA 94062-3813
Phone (650) 209-1100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 29981 | Other | CA | CORDILLERAS MHRC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1639526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788998400000",
"number": "1609535756",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "240 EDMONDS RD BLDG D",
"city": "REDWOOD CITY",
"state": "CA",
"postal_code": "940623813",
"telephone_number": "650-209-1100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "240 EDMONDS RD",
"city": "REDWOOD CITY",
"state": "CA",
"postal_code": "940623813",
"telephone_number": "650-209-1100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "EVELYN",
"middle_name": "ROSIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-12-15",
"last_updated": "2026-09-10",
"certification_date": "2026-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "167G00000X",
"taxonomy_group": "",
"desc": "Licensed Psychiatric Technician",
"state": "CA",
"license": "29981",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CORDILLERAS MHRC",
"identifier": "29981",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Redwood City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.