Provider Demographics
NPI:1164297289
Name:JACKSON, JASHAVIA
Entity Type:Individual
Prefix:
First Name:JASHAVIA
Middle Name:
Last Name: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 1:8790 WATERSOUND CIR APT 2
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-4363
Mailing Address - Country:US
Mailing Address - Phone:863-253-1285
Mailing Address - Fax:
Practice Address - Street 1:8790 WATERSOUND CIR APT 2
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-4363
Practice Address - Country:US
Practice Address - Phone:863-253-1285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst