Jackson, Marry Emma

Jackson, Marry Emma is an individual health care provider with primary practice located at 5290 Cobblegate Drive 7Th Floor, Moraine OH 45439-4540. She recently has only one registered license in Behavioral Health & Social Service Providers / Behavior Technician, which is considered as her primary health care specialty. Jackson, Marry Emma can be contacted via phone (937) 293-2510.

Contact Information

Primary practice address
5290 Cobblegate Drive 7Th Floor Moraine OH 45439-4540
Phone: (937) 293-2510
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavior Technician 106S00000X

Profile Details

NPI number 1871254631
LBN Legal business name Jackson, Marry Emma
Credentials QMHS ASSOC
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 4th, 2022
Last updated Jan 4th, 2022 - about 4 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1871254631 NPPES
Ohio MEDICAID 0301947

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