MR. KENNETH T JACKSON (NPI# 1639469026) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639469026 |
| Entity Type | Individual |
| Full Name | MR. KENNETH T JACKSON |
| Credential | MASTERS |
| Practice Address |
25506 Virginia Dr Warren MI 48091-6002 |
| Practice Telephone | 3134925119 |
| Mailing Telephone | 3134925119 |
| Enumeration Date | 2011-04-19 |
| Last Update Date | 2011-04-19 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
MI | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174083810 | Kenneth Jason Jackson | Student in an Organized Health Care Education/Training Program | 320 23rd St S Apt 1418, Arlington, VA 22202-3773 | 2019-03-20 |
| 1396968863 | Kenneth J Jackson | Dentist | 809 Redskin Trail, Wapakoneta, OH 45895 | 2007-04-11 |
| 1972510352 | Kenneth Wayne Jackson | Nurse Practitioner | 1811 Memorial Dr, Clarksville, TN 37043-4604 | 2006-08-01 |
| 1487606943 | Kenneth Wade Jackson Jr. | Obstetrics & Gynecology | 22 Manningfield Dr, Fletcher, NC 28732-9457 | 2006-05-16 |
| 1275514994 | Kenneth Conrad Jackson II | Pharmacist | 546 Chipeta Way, Suite 220, Salt Lake City, UT 84108-1236 | 2005-11-09 |
| 1407409063 | Kenneth Jackson | Technician | 1005 Terminal Way Ste 125, Reno, NV 89502-2198 | 2019-07-22 |
| 1457857690 | Kenneth D Jackson | Counselor | 2775 State Route 39, Shelby, OH 44875-9466 | 2018-04-05 |
| 1528573714 | Kenneth Jackson | Case Manager/Care Coordinator | 1501 Madison Rd, Walnut Hills, OH 45206-1706 | 2017-12-10 |
| 1003328550 | Kenneth Lee Jackson Jr. | Counselor | 1430 S High St Fl 4, Columbus, OH 43207-1045 | 2017-10-24 |
| 1942674411 | Kenneth David Jackson Jr. | Case Manager/Care Coordinator | 3901 Ulloa St, New Orleans, LA 70119-6942 | 2015-11-21 |
| Street Address |
25506 VIRGINIA DR |
| City | WARREN |
| State | MI |
| Zip Code | 48091-6002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548615172 | Amanda Lynn Kelsey | Nurse Practitioner | 21647 Ryan Road, Warren, MI 48091 | 2016-05-02 |
| 1902284474 | Daejana Maldonado | Licensed Practical Nurse | 7519 Toepfer, Warren, MI 48091 | 2015-05-15 |
| 1245637743 | Jerami Roy | Recreation Therapist | 7086 E 9 Mile, Warren, MI 48091 | 2014-11-26 |
| 1265698344 | Amanda Sarah Yousif-mansour | Dentist | 2442 E 10 Mile Road, Warren, MI 48091 | 2008-07-29 |
| 1326171166 | Sunshine Dental Center PC | Dentist | 21761 Ryan Rd, Warren, MI 48091 | 2007-03-13 |
| 1487709630 | Albert Spickers | General Practice | 26193 Meredith Drive, Warren, MI 48091 | 2007-01-25 |
| 1487706859 | Rita Jean Rose | Physician Assistant | 2104 E. 11 Mile Road, Suite 600, Warren, MI 48091 | 2007-01-17 |
| 1790835452 | Cole Vision Corporation | Eyewear Supplier (Equipment, not the service) | 2000 Ten Mile Rd., Warren, MI 48091 | 2007-01-12 |
| 1942363759 | Carolyn Joan Sucaet | Physical Therapist | 20952 12 Mile Road, Suite 110, St. Clair Shores, FM 48091 | 2006-12-19 |
| 1013070135 | Mcnichols Xray Clinic PC | Radiology | 21230 Dequindre Road, Southeast Michigan Surgical Hospital, Warren, MI 48091 | 2006-12-19 |
| Find all providers in zip 48091 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932747888 | Open Water Counseling and Recovery, LLC | Counselor | 1725 Drexel Ave Nw, Warren, OH 44485-2121 | 2019-12-11 |
| 1124663935 | A Restored Outlook LLC | Counselor | 8287 Linda St, Warren, MI 48093-2838 | 2019-11-15 |
| 1063075356 | Just Ask and I'll Help Mental Health Services | Counselor | 29648 City Center Dr Apt 3, Warren, MI 48093-2415 | 2019-04-22 |
| 1598273963 | Luke Charles Metcalf | Counselor | 1212 Tod Pl Nw, Warren, OH 44485-2475 | 2018-01-18 |
| 1518405018 | Rachel Soroka | Counselor | 160 Clifton Dr Ne, Warren, OH 44484-1820 | 2017-02-03 |
| 1538528534 | Joseph Burger | Counselor | 13520 Dominic Dr, Warren, MI 48088-1817 | 2016-02-18 |
| 1164890224 | Lashella Savage | Counselor | 14160 E 14 Mile Rd, Warren, MI 48088-5701 | 2015-09-07 |
| 1053728030 | Jane Kennedy Bays | Counselor | 30521 Schoenherr Rd Ste 200, Warren, MI 48088 | 2014-07-22 |
| 1073851044 | Michael Andrew Perkins | Counselor | 21760 Logue Ave, Warren, MI 48091-2352 | 2013-01-24 |
| 1194069245 | Latina Marie Johnson | Counselor | 29192 Aline Dr, Warren, MI 48093-2691 | 2012-11-15 |
| Find all providers in WARREN | ||||
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| 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.