Jackson Therapy
NPI 1164080693ActiveOrganization· Social Worker, Clinical· Urbana, IL
Social Worker, Clinical in Urbana, Illinois, registered in NPPES in May 2019. The authorized official on file is Angela Jackson, LCSW, Owner/Lead Therapist. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1164080693 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | May 30, 2019 |
| Last updated in NPPES | Mar 30, 2023 |
| Certified by provider | Mar 30, 2023 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Social Worker, Clinical Primary | 1041C0700X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (IL) |
|---|
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