NPIMap

Organization Active NPI

Jackson Innovations PLLC

  • Clinical Social Worker
  • Southfield, MI
National Provider Identifier
1750405734
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801059515 Issued in MI
Legal business name
JACKSON INNOVATIONS PLLC
Practice address
20700 Civic Center Dr
Suite 170
Southfield, MI 48076-4140
Phone
(248) 569-9846
Fax
(248) 569-1919
NPI assigned
Mar 16, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Gaynella Jackson, LMSWNPI 1154445138
Title
Clinical Director
Phone
(248) 569-9846

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6801059515 MI Primary

Addresses

Primary practice location

20700 Civic Center Dr
Suite 170
Southfield, MI 48076-4140

Mailing address

20700 Civic Center Dr
Suite 170
Southfield, MI 48076-4140
Phone (248) 569-9846

National Provider Directory

National Provider Directory

Locations

20700 Civic Center Dr
Ste 170
Southfield, MI 48076
Phone (248) 569-9846

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1750405734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20700 CIVIC CENTER DR",
            "address_2": "SUITE 170",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480764140",
            "telephone_number": "248-569-9846",
            "fax_number": "248-569-1919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20700 CIVIC CENTER DR",
            "address_2": "SUITE 170",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480764140",
            "telephone_number": "248-569-9846",
            "fax_number": "248-569-1919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON INNOVATIONS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "GAYNELLA",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "248-569-9846",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801059515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.