| Jackson Therapy | |
|
404 W Green St Urbana IL 61801-3267 | |
| (217) 706-5498 | |
| (217) 706-5779 |
| Full Name | Jackson Therapy |
|---|---|
| Speciality | Social Worker |
| Location | 404 W Green St, Urbana, Illinois |
| Authorized Official Name and Position | Angela Jackson (OWNER/LEAD THERAPIST) |
| Authorized Official Contact | 2178404090 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson Therapy 230 W Main St Decatur IL 62523-1215 Ph: (217) 706-5498 | Jackson Therapy 404 W Green St Urbana IL 61801-3267 Ph: (217) 706-5498 |
| NPI Number | 1164080693 |
|---|---|
| Provider Enumeration Date | 05/30/2019 |
| Last Update Date | 03/30/2023 |
| Certification Date | 03/30/2023 |
| Medicare PECOS PAC ID | 5496120198 |
|---|---|
| Medicare Enrollment ID | O20230411002542 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164080693 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Angela Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144597899 PECOS PAC ID: 4981860426 Enrollment ID: I20120727000039 |
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