Provider Demographics
NPI:1982211355
Name:JACKSON, KRISTEN IMANI (CSW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:IMANI
Last Name:JACKSON
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 GENTILLY BLVD STE C-400
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-1700
Mailing Address - Country:US
Mailing Address - Phone:504-944-0453
Mailing Address - Fax:504-944-0095
Practice Address - Street 1:1995 GENTILLY BLVD STE C-400
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-1700
Practice Address - Country:US
Practice Address - Phone:504-944-0453
Practice Address - Fax:504-944-0095
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator