Jackson, Destiny

Jackson, Destiny is an individual health care provider with primary practice located at 3518 W 25Th St , Cleveland OH 44109-1951. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Speech, Language and Hearing Service Providers / Hearing Instrument Specialist, Other Service Providers / Case Manager/Care Coordinator. Other Service Providers / Case Manager/Care Coordinator is her primary health care specialty. Jackson, Destiny can be contacted via phone (216) 741-2241.

Contact Information

Primary practice address
3518 W 25Th St Cleveland OH 44109-1951
Phone: (216) 741-2241
Fax: (216) 459-9821
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 23003122 Ohio
Speech, Language and Hearing Service Providers / Hearing Instrument Specialist 237700000X IL.03403 Ohio
Other Service Providers / Case Manager/Care Coordinator 171M00000X

Profile Details

NPI number 1255942157
LBN Legal business name Jackson, Destiny
Credentials HAS
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 13th, 2020
Last updated Jul 19th, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255942157 NPPES
Ohio MEDICAID 0325500

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