MS. SANDRA J JACKSON


Address: 4218 Western Ave., South Bend, IN 46619
Phone: 5742331524

MS. SANDRA J JACKSON (NPI# 1124449053) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1124449053
Entity Type Individual
Full Name MS. SANDRA J JACKSON
Credential LCAC CADAC IV NADAC
Practice Address 4218 Western Ave.
South Bend
IN 46619
Practice Telephone 5742331524
Mailing Telephone 5742741524
Mailing Fax Number 5742741612
Enumeration Date 2013-12-19
Last Update Date 2013-12-19
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 101YA0400X Counselor
Specialization: Addiction (Substance Use Disorder)
88000353A IN Behavioral Health & Social Service Providers

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1619118288 Sandra Denise Jackson Durable Medical Equipment & Medical Supplies 4303 Herridge St, Houston, TX 77022-3944 2009-03-11
1740425735 Sandra Renee Jackson Physical Therapist 4476 Winding Creek Rd, Manlius, NY 13104-2482 2008-12-05
1255535860 Sandra Denise Jackson Licensed Vocational Nurse 708 Bond St, Copperas Cove, TX 76522-3079 2007-06-14
1316089840 Sandra Gordon Jackson Social Worker 2121 Sage Rd Ste 180, Houston, TX 77056-4326 2007-02-12
1326195959 Sandra Jackson Social Worker 2750 N Lakeview Dr, Warsaw, IN 46582-8408 2007-01-04
1366459778 Sandra G. Jackson Counselor 1900 E. Tenth Street, Alamogordo, NM 88310 2006-08-01
1396717286 Sandra F Jackson Nurse Practitioner 23 W 37th St, Wilmington, DE 19802-2225 2006-02-03

Office Location

Street Address 4218 WESTERN AVE.
City SOUTH BEND
State IN
Zip Code 46619

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1578015103 Martin's Super Markets, Inc. Pharmacy 525 S. Mayflower Rd, South Bend, IN 46619 2016-10-31
1902227911 Patricia Ann Miller Counselor 4218 Western Ave, South Bend, IN 46619 2013-12-17
1740611953 Cynthia G. Finney Counselor 4218 Western Avenue, So Bend, IN 46619 2013-12-13
1437433406 Angela Nicole Zolvinski Pharmacist 4444 W. Western Ave, South Bend, IN 46619 2011-10-07
1871674556 The Health and Hospital Corporation of Marion County Skilled Nursing Facility 4600 W Washington St, South Bend, IN 46619 2006-10-18
1942302203 April Holtgren Family Medicine 1901 #b Western Ave, South Bend, IN 46619 2006-09-05
1447737002 Graciela Jimenez-martinez Registered Nurse 1901 #b Western Avenue, South Bend, IN 46619 2018-07-25
1821397878 Wright Dream In Home Supportive Care 706 S Sheridan St, South Bend, IN 46619 2011-03-16
1740439223 Scott J. Vanslambrouck Dentist 1901 #b Western Avenue, Ihc South Bend, South Bend, IN 46619 2008-09-09
1174626014 Indiana Health Centers, Inc. Dentist 1901 #b Western Ave, South Bend, IN 46619 2006-09-06
Find all providers in zip 46619

Taxonomy Information

Taxonomy Code 101YA0400X
Grouping Behavioral Health & Social Service Providers
Classification Counselor
Specialization Addiction (Substance Use Disorder)

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1346632957 Joel A Mccleary Counselor 17815 Woodthrush Ln, South Bend, IN 46635-1329 2015-02-19
1295123693 Perry Minner Jr. Counselor 430 E Lasalle Ave, South Bend, IN 46617-2724 2015-01-07
1902227911 Patricia Ann Miller Counselor 4218 Western Ave, South Bend, IN 46619 2013-12-17
1730526823 Thomas Eugene Hoff Counselor 1409 Enchanted Forest St, South Bend, IN 46637-4730 2013-05-29
1174738439 Pearl A. Anderson Counselor 4005 W Western Ave, South Bend, IN 46619-2617 2007-05-11
1972629327 Pamela H Forsey Counselor 2319 Edison Rd, South Bend, IN 46615-3515 2007-03-21
1578190815 Jeremy Sean Molica Counselor 4218 W Western Ave, South Bend, IN 46619-2622 2020-03-26
1700420023 Rachael Elizabeth Amor Counselor 3606 E Jefferson Blvd, South Bend, IN 46615-3052 2019-10-30
1821593989 Keilah Ehrman Counselor 1102 Fellows St, South Bend, IN 46601-3514 2018-03-29
1881120798 Shakira Desavoir Counselor 1402 S Michigan St, South Bend, IN 46613-2214 2017-05-11
Find all providers in SOUTH BEND

Competitor

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City SOUTH BEND
Zip Code 46619

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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