Jackson, Venella
Jackson, Venella is an individual health care provider with primary practice located at 6755 N 83Rd Ave Apt 15103 , Glendale AZ 85303-2756. She recently has only one registered license in Behavioral Health & Social Service Providers / Social Worker, which is considered as her primary health care specialty. Jackson, Venella can be contacted via phone (623) 312-7768.Contact Information
Primary practice address
6755 N 83Rd Ave Apt 15103
Glendale AZ 85303-2756
Phone: (623) 312-7768
Fax: (602) 279-1431
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Social Worker | 104100000X | 9262510 | Arizona |
Profile Details
| NPI number | 1427533363 |
|---|---|
| LBN Legal business name | Jackson, Venella |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 26th, 2018 |
| Last updated | Sep 26th, 2018 - about 8 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 | 1427533363 | NPPES |
| Arizona | Other | 9262510 | DCS/OLR LICENSING AUTHORITY |
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