MR. KENNETH ALAN JACKSON (NPI# 1891085783) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891085783 |
| Entity Type | Individual |
| Full Name | MR. KENNETH ALAN JACKSON |
| Credential | BS, LADC |
| Practice Address |
3329 University Ave Se Minneapolis MN 55414-3325 |
| Practice Telephone | 6124542285 |
| Practice Fax Number | 6124542340 |
| Mailing Telephone | 6124542285 |
| Mailing Fax Number | 6124542340 |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2011-04-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
302997 | MN | 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 |
| 1639469026 | Kenneth T Jackson | Counselor | 25506 Virginia Dr, Warren, MI 48091-6002 | 2011-04-19 |
| 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 |
| Street Address |
3329 UNIVERSITY AVE SE |
| City | MINNEAPOLIS |
| State | MN |
| Zip Code | 55414-3325 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558495010 | Alliance Clinic, LLC | Substance Abuse Rehabilitation Facility | 3329 University Ave Se, Minneapolis, MN 55414-3325 | 2007-03-15 |
| 1194124172 | Veronica Stake | Counselor | 3329 University Ave Se, Minneapolis, MN 55414-3325 | 2014-08-15 |
| 1669880019 | Lori Zobel | Counselor | 3329 University Ave Se, Minneapolis, MN 55414-3325 | 2014-07-30 |
| 1891102836 | Mallory Potter | Counselor | 3329 University Ave Se, Minneapolis, MN 55414-3325 | 2014-07-22 |
| 1508272527 | Douglas Gerlach | Counselor | 3329 University Ave Se, Minneapolis, MN 55414-3325 | 2014-07-10 |
| 1699181610 | Amanda Sue Anker | Counselor | 3329 University Ave Se, Minneapolis, MN 55414-3325 | 2014-07-10 |
| 1265847149 | Olalekan Patrick Obadiya | Nurse Practitioner | 3329 University Ave Se, Minneapolis, MN 55414-3325 | 2014-06-30 |
| 1467880278 | Meridian Behaivoral Health | Case Management | 3329 University Ave Se, Minneapolis, MN 55414-3325 | 2013-10-15 |
| 1538597380 | Timothy Groth | Counselor | 3329 University Ave Se, Minneapolis, MN 55414-3325 | 2013-10-14 |
| 1316287212 | Marlene Ann Thomseth-belcher | Counselor | 3329 University Ave Se, Minneapolis, MN 55414-3325 | 2013-03-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407496516 | Liza N Meredith | Psychologist | Acacia Counseling and Wellness, 2724 University Ave Se Unit B, Minneapolis, MN 55414 | 2020-01-07 |
| 1346888732 | Danielle Lee Ann Vogler-bos | Naturopath | 575 Se 9th St, Suite #52, Minneapolis, MN 55414 | 2019-12-16 |
| 1164071148 | Amy C Moran | Psychologist | Acacia Counseling & Wellness, 2724 University Ave., Unit B, Minneapolis, MN 55414 | 2019-09-11 |
| 1346806585 | Kristen Bastug | Student in an Organized Health Care Education/Training Program | General Pediatrics and Adolescent Health, 1932k, 1717 Delaware Street Southeast, Suite 353, Minneapolis, MN 55414 | 2019-05-14 |
| 1053881698 | Lauren Michelle Scholder | Psychologist | 401 Main St Se Apt 7009, Minneapolis, MN 55414 | 2018-11-27 |
| 1427530666 | Kelli Howard | Psychologist | 2724 University Ave Se Unit B, Minneapolis, MN 55414 | 2018-09-04 |
| 1306370218 | Jiexiong Yang | Student in an Organized Health Care Education/Training Program | 814 Essex St Se, Minneapolis, MN 55414 | 2017-04-18 |
| 1598297699 | Patrick Curran | Student in an Organized Health Care Education/Training Program | 628 University Ave Se, Apt. 112, Minneapolis, MN 55414 | 2017-03-29 |
| 1679923957 | Jillian Theresa Tholen | Dietitian, Registered | 411 E Hennepin Ave, Minneapolis, MN 55414 | 2016-06-16 |
| 1073960290 | First Language Interpreter & Translation Services LLC | Interpreter | 2828 University Ave Se Suite 150, Minneapolis, MN 55414 | 2016-05-17 |
| Find all providers in zip 55414 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568062461 | Andrew Moe | Counselor | 2118 Blaisdell Ave S., Minneapolis, MN 55404 | 2020-10-29 |
| 1366056392 | Brianna Connor | Counselor | 2450 Riverside Ave Bldg Suite140, Minneapolis, MN 55454-1450 | 2020-09-08 |
| 1144831959 | Brian James Rose | Counselor | 5061 Lyndale Ave S, Minneapolis, MN 55419-1215 | 2020-08-14 |
| 1740891688 | Jennifer Twa | Counselor | 2104 Stevens Ave, Minneapolis, MN 55404-2533 | 2020-08-13 |
| 1568072254 | Marian Margaret Spiess | Counselor | 2200 1st Ave S, Minneapolis, MN 55404-3401 | 2020-08-06 |
| 1689201352 | Alyssa Mary Nyberg | Counselor | 2960 Winnetka Ave N Ste 1010, Minneapolis, MN 55427-2853 | 2020-03-24 |
| 1497392666 | Kristine Geraldine Hanson | Counselor | 2611 40th Ave S, Minneapolis, MN 55406-1862 | 2019-12-05 |
| 1265080501 | Carolyn J Niesche | Counselor | 2518 N 2nd St Ste 113, Minneapolis, MN 55411-2259 | 2019-08-29 |
| 1053966069 | Shane Jensen | Counselor | 610 22nd Ave S, Minneapolis, MN 55454-1315 | 2019-08-06 |
| 1114584760 | Lynn Marie Allar | Counselor | 2200 E Franklin Ave Ste 200a, Minneapolis, MN 55404-2395 | 2019-05-20 |
| Find all providers in MINNEAPOLIS | ||||
| City | MINNEAPOLIS |
| Zip Code | 55414 |
Please comment or provide details below to improve the information on MR. KENNETH ALAN JACKSON.
| 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.