Matthew Jackson, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6801117121 Issued in MI

Practice address

4341 S Westnedge Ave
Kalamazoo, MI 49008-3289

Phone

(269) 241-3772

NPI assigned

Jul 17, 2019

Last updated

Sep 29, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mjackson@stjoecmh.org

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.

• Community Mental Health Services of St Joseph County

  dba Community Mental Health and Substance Abuse Services of St Joseph Coun

  • Community/Behavioral Health Agency
  • Centreville, MI
  • NPI 1366438483
  Medicare reassignment NPD
• Richard Kneip, PH.D., P.C.

  dba Great Lakes Psychology Group

  • Community/Behavioral Health Agency
  • Clarkston, MI
  • NPI 1679739700
  Medicare reassignment NPD

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

{
    "created_epoch": "1563321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759104000000",
    "number": "1922651041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 PLEASANT DR",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490025604",
            "telephone_number": "269-205-8317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4341 S WESTNEDGE AVE",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490083289",
            "telephone_number": "269-241-3772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MATTHEW",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-17",
        "last_updated": "2025-09-29",
        "certification_date": "2025-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801101413",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801117121",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801117121",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LARA",
            "identifier": "6801117121",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mjackson@stjoecmh.org",
            "affiliation": "N",
            "endpointDescription": "Business email",
            "address_1": "677 E Main St",
            "city": "Centreville",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490328524",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• De Lorenco L Jackson
• Kathy Jo Jackson, M.D.
• Kayla Jackson
• Larry Jackson, M.D.
• Lluvia Ivonne Jackson, LLMSW
• Peyton Jackson
• Yvonne Denise Jackson, PT
• John Jacob, MD
• Alexis Lynn Jacobs, BSW
• Brian Jacobs

• Social Worker in Kalamazoo, MI
• Providers in Kalamazoo, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.