| Marsha W Jackson Lisw, Llc | |
|
4500 Cooper Rd Ste 303 Blue Ash OH 45242-5600 | |
| (513) 942-1862 | |
| Not Available |
| Full Name | Marsha W Jackson Lisw, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4500 Cooper Rd Ste 303, Blue Ash, Ohio |
| Authorized Official Name and Position | Marsha W Jackson (OWNER) |
| Authorized Official Contact | 5139421862 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Marsha W Jackson Lisw, Llc 4500 Cooper Rd Ste 303 Blue Ash OH 45242-5600 Ph: (513) 942-1862 | Marsha W Jackson Lisw, Llc 4500 Cooper Rd Ste 303 Blue Ash OH 45242-5600 Ph: (513) 942-1862 |
| NPI Number | 1548765571 |
|---|---|
| Provider Enumeration Date | 03/30/2018 |
| Last Update Date | 11/16/2023 |
| Certification Date | 11/16/2023 |
| Medicare PECOS PAC ID | 1658627088 |
|---|---|
| Medicare Enrollment ID | O20180627001967 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548765571 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| Provider Name | Marsha W Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598934846 PECOS PAC ID: 0345319547 Enrollment ID: I20160714001394 |
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