Gaynella Jackson is a Clinical in Southfield, Michigan. Gaynella Jackson practices all healthcare services and medical treatments related to Clinical. The NPI Number for Gaynella Jackson is 1154445138. The last update date is 2007-07-09.
Gaynella Jackson's current location address is 20700 Civic Center Dr, Southfield, Michigan. You can contact this provider via phone number 2485699846 and fax number 2485691919. The mailing address for Gaynella Jackson is 20700 Civic Center Dr, Southfield, Michigan. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Gaynella Jackson |
|---|---|
| Address | 20700 Civic Center Dr, Southfield, Michigan |
| Phone Number | 2485699846 |
| Fax Number | 2485691919 |
| Sole Proprietor | Y |
| Credentials | LMSW |
NPI Number Detail
| NPI Number | 1154445138 |
|---|---|
| Provider Enumeration Date | 2007-03-16 |
| Last Updated Date | 2007-07-09 |
Provider Mailing Address Detail
| Address | 20700 Civic Center Dr |
|---|---|
| City | Southfield |
| State | Michigan (MI) |
| Post Code | 480764140 |
| Phone Number | 2485699846 |
| Fax Number | 2485691919 |
Provider's Primary Taxonomy Detail
| Speciality | Clinical |
|---|---|
| Taxonomy | 1041C0700X |
| Licence No | 6801059515 |
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Definition: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certif |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 80-0-89-6833-0 | MI | BLUE CROSS BLUE SHIELD OF |
Post Comment/ Review Below
What is the unique 10-digit identification code issued to Gaynella Jackson by the Centers for Medicare & Medicaid Services?
The Gaynella Jackson has been assigned the NPI (National Provider Identifier) 1154445138 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for healthcare providers.
Could you please provide the complete street address where Gaynella Jackson is physically located?
The Gaynella Jackson is physically situated at the following address: 20700 Civic Center Dr, Southfield, MI, 480764140.
What is the area of specialization for Gaynella Jackson, and what is the corresponding taxonomy classification code for this field?
The specialized field of practice for Gaynella Jackson is Clinical, and the corresponding taxonomy code that categorizes this area of expertise is 1041C0700X.
On what date did the Centers for Medicare & Medicaid Services issue the 1154445138 to Gaynella Jackson?
The Gaynella Jackson received its 1154445138 assignment from the Centers for Medicare & Medicaid Services on 2007-03-16.
When was the information pertaining to Gaynella Jackson most recently updated or revised?
The details related to Gaynella Jackson, including its address, specialty, and other relevant information, were last updated or revised on 2007-07-09.