| C Wesley Jackson Jr Phd Inc | |
|
2980 Washington Blvd Cleveland Heights OH 44118-2450 | |
| (216) 321-9355 | |
| (216) 932-3341 |
| Full Name | C Wesley Jackson Jr Phd Inc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 2980 Washington Blvd, Cleveland Heights, Ohio |
| Authorized Official Name and Position | C Wesley Jackson (PRESIDENT OWNER) |
| Authorized Official Contact | 2163219355 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| C Wesley Jackson Jr Phd Inc 2980 Washington Blvd Cleveland Heights OH 44118-2450 Ph: (216) 321-9355 | C Wesley Jackson Jr Phd Inc 2980 Washington Blvd Cleveland Heights OH 44118-2450 Ph: (216) 321-9355 |
| NPI Number | 1720202500 |
|---|---|
| Provider Enumeration Date | 04/12/2007 |
| Last Update Date | 07/30/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720202500 | NPI | - | NPPES |
| 0253309 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 474 (Ohio) | Primary |
| 103TC0700X | Psychologist - Clinical | 000519 (Michigan) | Secondary |
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