Provider Demographics
NPI:1548765571
Name:MARSHA W JACKSON
Entity Type:Organization
Organization Name:MARSHA W JACKSON
Other - Org Name:MARSHA W JACKSON LISW, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:W
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:513-942-1862
Mailing Address - Street 1:4500 COOPER RD STE 303
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5600
Mailing Address - Country:US
Mailing Address - Phone:513-942-1862
Mailing Address - Fax:
Practice Address - Street 1:4500 COOPER RD STE 303
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-5600
Practice Address - Country:US
Practice Address - Phone:513-942-1862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-30
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty