Provider Demographics
NPI:1659242964
Name:JACKSON, JACLYN NICOLE (MA, PPS)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:NICOLE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MA, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-2442
Mailing Address - Country:US
Mailing Address - Phone:925-473-2490
Mailing Address - Fax:
Practice Address - Street 1:50 E 8TH ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-2442
Practice Address - Country:US
Practice Address - Phone:925-473-2490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool