Provider Demographics
NPI:1194846758
Name:WEBB-JACKSON, MARGARET THERESE
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:THERESE
Last Name:WEBB-JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:T
Other - Last Name:WEBB-JACKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17849 MARGATE ST
Mailing Address - Street 2:UNIT 313
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3201
Mailing Address - Country:US
Mailing Address - Phone:818-357-9907
Mailing Address - Fax:
Practice Address - Street 1:12450 VAN NUYS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-1391
Practice Address - Country:US
Practice Address - Phone:818-896-5069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7068Medicaid
CA7420Medicaid