Provider Demographics
NPI:1295466092
Name:JAXON, JILANA
Entity Type:Individual
Prefix:
First Name:JILANA
Middle Name:
Last Name:JAXON
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 1:245 S 45TH ST APT B1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3597
Mailing Address - Country:US
Mailing Address - Phone:608-957-5714
Mailing Address - Fax:
Practice Address - Street 1:1819 JOHN F KENNEDY BLVD STE 302
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1729
Practice Address - Country:US
Practice Address - Phone:610-265-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health