Provider Demographics
NPI:1013436831
Name:JACKSON, KAYLA MICHELLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:MICHELLE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:KAYLA
Other - Middle Name:MICHELLE
Other - Last Name:HINKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1099 N MERIDIAN ST STE 900
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1030
Mailing Address - Country:US
Mailing Address - Phone:317-988-1418
Mailing Address - Fax:
Practice Address - Street 1:1099 NORTH MERIDIAN STREET
Practice Address - Street 2:SUITE 900
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204
Practice Address - Country:US
Practice Address - Phone:317-988-1418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008189A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical