Kellie Jackson, is a
Social Worker based in Pasadena, California. Kellie Jackson is licensed to practice in California (license number 112050) and her current practice location is
100 W Walnut St Ste 375, Pasadena, California. She can be reached at her office (for appointments etc.) via phone at
(626) 395-7100.
NPI number for Kellie Jackson is 1538604673 and her current mailing address is 100 W Walnut St Ste 375, Pasadena, California. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1538604673.
Healthcare Provider's Profile
| Full Name | Kellie Jackson |
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| Gender | Female |
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| Speciality | Social Worker |
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| Location | 100 W Walnut St Ste 375, Pasadena, California |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1538604673
- Provider Enumeration Date: 12/28/2016
- Last Update Date: 06/23/2023
Medical Identifiers
Medical identifiers for Kellie Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1538604673 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YM0800X | Counselor - Mental Health | 112050 (California) | Secondary |
| 225400000X | Rehabilitation Practitioner | (* (Not Available)) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Secondary |
| 104100000X | Social Worker | 112050 (California) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kellie Jackson is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Kellie Jackson,
100 W Walnut St Ste 375,
Pasadena, CA 91124-0001
Ph: (626) 395-7100 | Kellie Jackson,
100 W Walnut St Ste 375,
Pasadena, CA 91124-0001
Ph: (626) 395-7100 |
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