Nicole Marie Jackson, BT

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

1810 Chartwell Dr
Traverse City, MI 49696-9283

Phone

(231) 929-2354

Fax

(231) 929-2853

NPI assigned

Nov 18, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Nicole Marie Mausolf Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Theology

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

{
    "created_epoch": "1668729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668729600000",
    "number": "1710696794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E WEXFORD AVE",
            "city": "BUCKLEY",
            "state": "MI",
            "postal_code": "496205107",
            "telephone_number": "231-493-3944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1810 CHARTWELL DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496969283",
            "telephone_number": "231-929-2354",
            "fax_number": "231-929-2853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "credential": "BT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-18",
        "last_updated": "2022-11-18",
        "certification_date": "2022-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "MAUSOLF",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• J. Eric Zimmerman, M.D., P.C.
• Jordan Jabara, MD
• Mark A Jackson, MD
• Matthew R Jackson, D.O.
• Neil Bradley Jackson, DC
• Sarah Kristen Jackson, MS
• Jacob White PH.D., PLLC
• Katelyn Jacobs, OTRL
• Matthew Jacobs
• Paul Anders Jacobson, M.D.

• Behavior Technician in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Behavior Technician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 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.