C Wesley Jackson Jr PHD Inc

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

474 Issued in OH

Legal business name

C WESLEY JACKSON JR PHD INC

Practice address

2980 Washington Blvd
Cleveland Heights, OH 44118-2450

Phone

(216) 321-9355

Fax

(216) 932-3341

NPI assigned

Apr 12, 2007

Organization subpart

No

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

Authorized official

Name

C Wesley Jackson Jr., PHD

Title

President Owner

Phone

(216) 321-9355

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343606400000",
    "number": "1720202500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2980 WASHINGTON BLVD",
            "city": "CLEVELAND HEIGHTS",
            "state": "OH",
            "postal_code": "441182450",
            "telephone_number": "216-321-9355",
            "fax_number": "216-932-3341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2980 WASHINGTON BLVD",
            "city": "CLEVELAND HEIGHTS",
            "state": "OH",
            "postal_code": "441182450",
            "telephone_number": "216-321-9355",
            "fax_number": "216-932-3341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C WESLEY JACKSON JR PHD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2012-07-30",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "C",
        "authorized_official_middle_name": "WESLEY",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "216-321-9355",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "474",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "000519",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0253309",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Alicia Butler
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• C.a.S. Health Investors, Inc.
• Melissa A Cabal
• Jazmine Caldwell
• Marleen Caldwell, P.T., M.S., CRED MDT
• Camhp Foundation

• Clinical Psychologist in Cleveland Heights, OH
• Providers in Cleveland Heights, OH by specialty
• Clinical Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2012; 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.