Provider Demographics
NPI:1336201698
Name:JACKSON-MAGEE, HATTIE (ASW)
Entity Type:Individual
Prefix:MS
First Name:HATTIE
Middle Name:
Last Name:JACKSON-MAGEE
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 ENTERPRISE DR
Mailing Address - Street 2:BLDG 2
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-5801
Mailing Address - Country:US
Mailing Address - Phone:707-399-4939
Mailing Address - Fax:707-399-4957
Practice Address - Street 1:1745 ENTERPRISE DR
Practice Address - Street 2:BLDG 2
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5801
Practice Address - Country:US
Practice Address - Phone:707-399-4939
Practice Address - Fax:707-399-4957
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical