Provider Demographics
NPI:1407422207
Name:JACKSON, JANICE
Entity Type:Individual
Prefix:
First Name:JANICE
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 1:555 MARRIOTT DR STE 315555
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-5020
Mailing Address - Country:US
Mailing Address - Phone:615-258-8400
Mailing Address - Fax:
Practice Address - Street 1:555 MARRIOTT DR STE 315
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-5088
Practice Address - Country:US
Practice Address - Phone:615-258-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician