Provider Demographics
NPI:1982464467
Name:JACKSON, EBONI NAPIER
Entity Type:Individual
Prefix:MRS
First Name:EBONI
Middle Name:NAPIER
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 TOMMY TRUE CT
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-4927
Mailing Address - Country:US
Mailing Address - Phone:410-365-4117
Mailing Address - Fax:
Practice Address - Street 1:122 S HAVEN ST UNIT 1F
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2429
Practice Address - Country:US
Practice Address - Phone:410-365-4117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor