EDNA ELIZABETH JACKSON MA NPI 1265819213

NPI Information

NPI: 1265819213
Provider Name: EDNA ELIZABETH JACKSON, MA
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
1430 OLIVE ST STE 400
SAINT LOUIS, MO
ZIP 63103
Phone: (314) 206-3700
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Edna Elizabeth Jackson, MA is an addiction (substance use disorder) counselor in Saint Louis, MO. Edna Elizabeth Jackson, MA NPI is 1265819213. 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:

1430 OLIVE ST STE 400
SAINT LOUIS, MO
ZIP 63103-303
Phone: (314) 206-3700

The enumeration date for this NPI number is 4/29/2015 and was last updated on 7/28/2022.

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	101YP1600X	Counselor	Pastoral			No
2	101YA0400X	Counselor	Addiction (Substance Use Disorder)			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	630	OTHER	MISSOURI	CRADC

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: 4/28/2024

NPI Synchronization or Removal

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