Manzetta L. Jackson, PH.D

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

E.0005572-SUPV. Issued in OH

Practice address

4334 W Central Ave Ste 211
Toledo, OH 43615-1679

Phone

(419) 902-0407

NPI assigned

Oct 3, 2013

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

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1380758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380758400000",
    "number": "1659708618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4334 W CENTRAL AVE STE 211",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436151679",
            "telephone_number": "419-902-0407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4334 W CENTRAL AVE STE 211",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436151679",
            "telephone_number": "419-902-0407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MANZETTA",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-10-03",
        "last_updated": "2013-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "E.0005572-SUPV.",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E.0005572-SUPV.",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyndra Jackson
• Laeia B Jackson, MD
• Leonna Jackson, LISW
• Lindsey Jackson, DO
• Makyia Janeece Jackson
• Michael Jackson Jr.
• Monica L. Jackson, LPN
• Nancy Jackson, MSW, LSW
• Nancy M Jackson
• Pamela Sue Jackson

• Mental Health Counselor in Toledo, OH
• Providers in Toledo, OH by specialty
• Mental Health Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 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.