Active NPI
Latonia Jackson
- Social Worker
- Middletown, OH
National Provider Identifier
1932938164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- S.0900958
- Practice address
- 220 S Breiel Blvd
Middletown, OH 45044-5106 - Phone
- (513) 849-8670
- NPI assigned
- Jul 27, 2024
- Last updated
- Jul 27, 2024
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | S.0900958 | OH | Primary |
Addresses
Primary practice location
220 S Breiel Blvd
Middletown, OH 45044-5106
Mailing address
9 Chesapeake PLZ
Chesapeake, OH 45619-1003
Phone (513) 849-8670
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S.0900958 | OH | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Phoenix Group Home, LLC | Current | Accepting new patients | |
| Phoenix Group Home, LLC | Past | Accepting new patients |
Locations
9 Chesapeake Plz
Chesapeake, OH 45619
Phone (740) 297-6019
220 S Briele Blvd
Middletown, OH 45044
Phone (513) 422-2598
Interoperability endpoints
- https://api.qualifacts.org/api/fhir/pathihc/r4/
Organizations & group practices 2
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.
-
dba PATH Integrated Healthcare
- Community/Behavioral Health Agency
- Portsmouth, OH
- NPI 1083146013
-
dba Path Behavioral Health- SUD
- Substance Abuse Rehabilitation Facility
- Cincinnati, OH
- NPI 1336654854
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1722038400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722038400000",
"number": "1932938164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 CHESAPEAKE PLZ",
"city": "CHESAPEAKE",
"state": "OH",
"postal_code": "456191003",
"telephone_number": "513-849-8670"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 S BREIEL BLVD",
"city": "MIDDLETOWN",
"state": "OH",
"postal_code": "450445106",
"telephone_number": "513-849-8670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "LATONIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-07-27",
"last_updated": "2024-07-27",
"certification_date": "2024-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "S.0900958",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Middletown, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.