Provider Demographics
NPI:1215568233
Name:JACKSON, TAYLOR (PLMSW, PLMHP)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PLMSW, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 BOYD ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68003
Mailing Address - Country:US
Mailing Address - Phone:402-304-9229
Mailing Address - Fax:833-365-7945
Practice Address - Street 1:128 S 17TH ST
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-2004
Practice Address - Country:US
Practice Address - Phone:402-304-9229
Practice Address - Fax:833-365-7945
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE73501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical