Nicole Vanessa Jackson, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801089011 Issued in MI

Practice address

39293 Plymouth Rd
Ste 109a
Livonia, MI 48150-1060

Phone

(734) 521-6579

Fax

(734) 943-6321

NPI assigned

Jul 17, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Nicole Vanessa Vaughn Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: nvaughn747115@direct.hfhs.org

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

{
    "created_epoch": "1247788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657497600000",
    "number": "1841420346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39293 PLYMOUTH RD",
            "address_2": "SUITE 109A",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481501060",
            "telephone_number": "734-521-6579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39293 PLYMOUTH RD",
            "address_2": "STE 109A",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481501060",
            "telephone_number": "734-521-6579",
            "fax_number": "734-943-6321"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "26300 Outer Dr",
            "address_purpose": "LOCATION",
            "city": "Lincoln Park",
            "state": "MI",
            "postal_code": "481462019",
            "country_code": "US",
            "telephone_number": "313-388-4630",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "NICOLE",
        "middle_name": "VANESSA",
        "name_prefix": "Mrs.",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-17",
        "last_updated": "2022-07-11",
        "certification_date": "2022-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801089011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "VAUGHN",
            "middle_name": "VANESSA",
            "prefix": "MRS.",
            "credential": "LMSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Daisah Jackson
• Deana Jackson
• Heather Jackson
• Kassandra Lynn Jackson, LMSW
• Mykerra Brieanna Jackson I
• Paul Jackson, D.O.
• Shantele Dennene Jackson
• Stephanie Jackson, LBSW, QMHP, QIDP
• Tayonna Jackson
• Zannie Roy Jackson Jr., PEER SUPPORT SPECIAL

• Clinical Social Worker in Livonia, MI
• Providers in Livonia, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 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.