Mary Stark Jacks, MSW

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

License

902213 Issued in AK

Practice address

2340 Sentry Dr Apt 805
Anchorage, AK 99507-5344

Phone

(907) 344-8869

Fax

(907) 868-3562

NPI assigned

May 18, 2007

Last updated

Jul 8, 2007By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Life Enrichment Services

  • Case Management Agency
  • Anchorage, AK
  • NPI 1700909785
  NPD (past) Authorized official

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821206376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 232245",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995232245",
            "telephone_number": "907-868-3562",
            "fax_number": "907-868-3562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2340 SENTRY DR APT 805",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995075344",
            "telephone_number": "907-344-8869",
            "fax_number": "907-868-3562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKS",
        "first_name": "MARY",
        "middle_name": "STARK",
        "name_prefix": "Ms.",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "AK",
            "license": "902213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J&L Homes, LLC
• Jacinta's Assisted Living Home
• Genevieve Jackman
• Karen Jackman, M.D
• Denise Jacko, OTR/L
• Paul Charles Jacks, BA
• Maggie Annie Jackson-Fairbanks
• Amber Jackson, LMT
• Bennett J Jackson, ANP
• Christopher Paul Jackson

• Case Manager/Care Coordinator in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Case Manager/Care Coordinator in Alaska

• 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.