Jackson, Jerry
Jackson, Jerry is an sole proprietor health care provider with primary practice located at 7937 Westmoreland Ave , Parkville MD 21234-5435. He recently has only one registered license in Behavioral Health & Social Service Providers / Social Worker, which is considered as his primary health care specialty. Jackson, Jerry can be contacted via phone (910) 528-2628.Contact Information
Primary practice address
7937 Westmoreland Ave
Parkville MD 21234-5435
Phone: (910) 528-2628
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Social Worker | 104100000X |
Profile Details
| NPI number | 1023549805 |
|---|---|
| LBN Legal business name | Jackson, Jerry |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 23rd, 2017 |
| Last updated | Mar 23rd, 2017 - about 7 years ago |
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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1023549805 | NPPES |
| Maryland | MEDICAID | 8121820487 |
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