Jerry Michael Jackson, MSW, ACSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LW00004286 Issued in WA

Practice address

11016 NE 2ND PL
Bellevue, WA 98004-5830

Phone

(425) 455-0348

Fax

(206) 367-0547

NPI assigned

Aug 31, 2006

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

Other identifiers 1

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1699887166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3723 NE 150TH ST",
            "city": "LAKE FOREST PARK",
            "state": "WA",
            "postal_code": "981557828",
            "telephone_number": "206-367-3351",
            "fax_number": "206-367-0547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11016 NE 2ND PL",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980045830",
            "telephone_number": "425-455-0348",
            "fax_number": "206-367-0547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JERRY",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "MSW, ACSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "LW00004286",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED SOCIAL WORKER",
            "identifier": "LW00004286",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joy Elaine Jack, CDP
• Amy Jackson
• August Jackson
• Charles G Jackson, MD
• Christopher L Jackson, MS, LMHC
• Kaitlin Josephine Jackson
• Sarah Catherine Jackson, OD
• Taylor Jackson
• Blessy Jacob, MD
• Kristin Liffick Jacob, O.D.

• Mental Health Counselor in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.