Provider Demographics
NPI:1801535570
Name:JACKSON, SHERRY C (RBT)
Entity type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:C
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:625 BAKERS BRIDGE AVE STE 105-21
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-1613
Mailing Address - Country:US
Mailing Address - Phone:615-631-8008
Mailing Address - Fax:615-503-8411
Practice Address - Street 1:625 BAKERS BRIDGE AVE STE 105-21
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-1613
Practice Address - Country:US
Practice Address - Phone:615-631-8008
Practice Address - Fax:615-503-8411
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-22-212938106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician