Provider Demographics
NPI:1558152983
Name:JACKSON, TIONNA (LSW)
Entity type:Individual
Prefix:
First Name:TIONNA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 E ROWLAND RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-2223
Mailing Address - Country:US
Mailing Address - Phone:419-407-6426
Mailing Address - Fax:
Practice Address - Street 1:5800 MONROE ST STE A1
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2208
Practice Address - Country:US
Practice Address - Phone:419-517-7073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1101515104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker