Provider Demographics
NPI:1497531255
Name:LEWIS- JACKSON, SKYLER ALYSS (MSW)
Entity Type:Individual
Prefix:
First Name:SKYLER
Middle Name:ALYSS
Last Name:LEWIS- JACKSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 ARLINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-2576
Mailing Address - Country:US
Mailing Address - Phone:916-316-7749
Mailing Address - Fax:
Practice Address - Street 1:303 ARLINGTON CIR
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2576
Practice Address - Country:US
Practice Address - Phone:916-316-7749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker