Provider Demographics
NPI:1003394727
Name:SEAY-JACKSON, JAZZMYN SIERRA
Entity Type:Individual
Prefix:
First Name:JAZZMYN
Middle Name:SIERRA
Last Name:SEAY-JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 A ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4113
Mailing Address - Country:US
Mailing Address - Phone:510-901-2050
Mailing Address - Fax:
Practice Address - Street 1:1149 A ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4113
Practice Address - Country:US
Practice Address - Phone:510-901-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF7717262103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst