Jacqueline Landa Jackson, M.ED., BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Practice address

901 W Trade St
Charlotte, NC 28202-1143

Phone

(718) 736-5689

NPI assigned

Feb 1, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

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 and National Provider Directory roles.

• Little Waves Viera, LLC

  • Behavior Analyst
  • Rockledge, FL
  • NPI 1578397261
  NPD Authorized official
• Blue Iris Behavioral Services Corp

  • Behavior Analyst
  • Palm Bay, FL
  • NPI 1023777935
  NPD (past)
• Collaborative ABA Services, LLC

  • Clinical Social Worker
  • Middletown, CT
  • NPI 1427619626

  Behavior Analyst

  NPD (past)

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

{
    "created_epoch": "1612137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691107200000",
    "number": "1861083909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2560 JUDGE FRAN JAMIESON WAY UNIT 1309",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329406199",
            "telephone_number": "860-759-8726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 W TRADE ST",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282021143",
            "telephone_number": "718-736-5689"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4640 Lipscomb St NE Ste 4",
            "address_purpose": "LOCATION",
            "city": "Palm Bay",
            "state": "FL",
            "postal_code": "329052986",
            "country_code": "US",
            "telephone_number": "321-327-4037",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JACQUELINE",
        "middle_name": "LANDA",
        "credential": "M.ED., BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-01",
        "last_updated": "2023-08-04",
        "certification_date": "2023-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CT",
            "license": "1123",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dianne Ruth Jackson, PT
• Elizabeth C Jackson, SLP
• Emanuel Mason Jackson, MD
• Erica Jackson, OT
• Henretta Collin Jackson, DMIN
• Jacquelyn Chrisana Jackson, MD
• Jalisa Jackson
• Jasmine Dearis Jackson, PHARMD
• Jennifer Davis Jackson, LCAS
• Jessica Lynn Jackson, FNP

• Behavior Analyst in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Behavior Analyst in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2023; 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.