Active NPI
Elizabeth Jackson
- Behavior Analyst
- Fort Wayne, IN
National Provider Identifier
1891206389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-17-25512
- Practice address
- 2270 Lake Ave Ste 101
Fort Wayne, IN 46805-5360 - Phone
- (260) 444-5649
- NPI assigned
- Oct 24, 2017
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-17-25512 | IN | Primary |
Addresses
Primary practice location
2270 Lake Ave Ste 101
Fort Wayne, IN 46805-5360
Mailing address
2270 Lake Ave Ste 101
Fort Wayne, IN 46805-5360
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": "1508803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1508803200000",
"number": "1891206389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2270 LAKE AVE STE 101",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468055360"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2270 LAKE AVE STE 101",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468055360",
"telephone_number": "260-444-5649"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ELIZABETH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-10-24",
"last_updated": "2017-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "IN",
"license": "1-17-25512",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.