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James Allen Jackson

Social Worker

Behavioral Health & Social Service Providers

5209 Point Fosdick Dr NW Ste 205, Gig Harbor, WA 98335

PECOS Enrollment

This provider is enrolled in PECOS as JAMES JACKSON.

Based on the most recent information from CMS, provider James Allen Jackson is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1811282247
Provider Type
Individual
Full Name
Jackson, James Allen
Title
Mr.
Credential
M.S.W.

Gender
Male
Sole Proprietor
Yes
Enumeration Date
6/14/2011
Last Updated
5/18/2019

Contact Information

Practice Location

5209 Point Fosdick Dr NW Ste 205, Gig Harbor, WA 98335

(253) 495-9311

Unlisted Fax

Mailing Location

5209 Point Fosdick Dr NW Ste 205, Gig Harbor, WA 98335-1728

(253) 495-9311

(253) 697-3730

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License LW00004709 Washington
Code 104100000X	Description Social Worker Behavioral Health & Social Service Providers	License Unlisted Issuer

Provider Identifiers

ID	Description	Issuer
ID LW00004709	Description Other	Issuer WA STATE DEPARTMENT OF HEALTH Washington

James Allen Jackson

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

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