Provider Demographics
NPI:1801127741
Name:JACKSON, SHERLEEN HARRIS (MSW, PHD)
Entity type:Individual
Prefix:DR
First Name:SHERLEEN
Middle Name:HARRIS
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 N CLASSEN BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-5809
Mailing Address - Country:US
Mailing Address - Phone:405-528-1748
Mailing Address - Fax:405-528-1802
Practice Address - Street 1:2220 N CLASSEN BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-5809
Practice Address - Country:US
Practice Address - Phone:405-528-1748
Practice Address - Fax:405-528-1802
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical