MS. NASTASSIA S JACKSON LPC-IT NPI 1720524341

NPI Information

NPI: 1720524341
Provider Name: MS. NASTASSIA S JACKSON, LPC-IT
Classification: Counselor - 101YM0800X
Entity Type: Individual

Specialization: Mental Health

Address:
6830 W VILLARD AVE STE 190
MILWAUKEE, WI
ZIP 53218
Phone: (262) 320-7886
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MS. Nastassia S Jackson, LPC-IT is a mental health counselor in Milwaukee, WI. MS. Nastassia S Jackson, LPC-IT NPI is 1720524341. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

6830 W VILLARD AVE STE 190
MILWAUKEE, WI
ZIP 53218
Phone: (262) 320-7886

The enumeration date for this NPI number is 1/7/2017 and was last updated on 6/18/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YM0800X	Counselor	Mental Health	2601	WISCONSIN	No
2	101YA0400X	Counselor	Addiction (Substance Use Disorder)			No
3	101YS0200X	Counselor	School			No
4	101YM0800X	Counselor	Mental Health	7435	WISCONSIN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	100071680	MEDICAID	WISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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