Active NPI
Jessica Jackson
- Behavior Analyst
- Southfield, MI
National Provider Identifier
1770940975
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 24024 Evergreen Rd Apt 108a
Southfield, MI 48075-5517 - Phone
- (313) 318-8618
- NPI assigned
- Jan 20, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | |||
| Other Technician | 247200000X | |||
| Behavior Analyst | 103K00000X | Primary |
Addresses
Primary practice location
24024 Evergreen Rd Apt 108a
Southfield, MI 48075-5517
Mailing address
31188 Misty Pines Dr
Farmington Hills, MI 48336-1256
Phone (248) 885-7613
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1453248000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614038400000",
"number": "1770940975",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31188 MISTY PINES DR",
"city": "FARMINGTON HILLS",
"state": "MI",
"postal_code": "483361256",
"telephone_number": "248-885-7613"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24024 EVERGREEN RD APT 108A",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480755517",
"telephone_number": "313-318-8618"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JESSICA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-01-20",
"last_updated": "2021-02-23",
"certification_date": "2021-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": null,
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"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 Feb 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.