Active NPI
Anita Denise Jackson, MA, LBSW
- Social Worker
- Redford, MI
National Provider Identifier
1851785620
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6802074632
- Practice address
- 9315 Telegraph Rd
Redford, MI 48239-1260 - Phone
- (313) 450-4500
- Fax
- (313) 450-4512
- NPI assigned
- Mar 19, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 6802074632 | MI | Primary |
| Clinical Social Worker | 1041C0700X | 6802074632 | MI |
Addresses
Primary practice location
9315 Telegraph Rd
Redford, MI 48239-1260
Mailing address
9315 Telegraph Rd
Redford, MI 48239-1260
Phone (313) 450-4500
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6802074632 | MI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1426723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647820800000",
"number": "1851785620",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9315 TELEGRAPH RD",
"city": "REDFORD",
"state": "MI",
"postal_code": "482391260",
"telephone_number": "313-450-4500",
"fax_number": "313-450-4512"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9315 TELEGRAPH RD",
"city": "REDFORD",
"state": "MI",
"postal_code": "482391260",
"telephone_number": "313-450-4500",
"fax_number": "313-450-4512"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ANITA",
"middle_name": "DENISE",
"credential": "MA, LBSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-03-19",
"last_updated": "2022-03-21",
"certification_date": "2022-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6802074632",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6802074632",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redford, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 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.