Provider Demographics
NPI:1841571593
Name:JACKSON, MEGIN O (MSW INTERN)
Entity Type:Individual
Prefix:MISS
First Name:MEGIN
Middle Name:O
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-5418
Mailing Address - Country:US
Mailing Address - Phone:562-599-9271
Mailing Address - Fax:
Practice Address - Street 1:240 E 20TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-5418
Practice Address - Country:US
Practice Address - Phone:562-599-9271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program