IndividualActive
Shantell Jackson
NPI 1992307870 · Intellectual & Developmental Disabilities Psychologist · Wickliffe, OH
Provider details
- NPI number
- 1992307870
- Entity type
- Individual
- Primary specialty
- Intellectual & Developmental Disabilities PsychologistBehavioral Health & Social Service Providers
- Sex
- Female
- Sole proprietor
- No
- License
- 4303862 (OH)
Specialties & taxonomies
Behavioral Health & Social Service Providers
Practice location
1834 Robindale St
Wickliffe, OH 44092-1843
Phone: (330) 368-2617
Approximate (ZIP-level) locationGet directions
Mailing address
1834 Robindale St
Wickliffe, OH 44092-1843
Registry dates
- Enumerated
- 2020-11-15
- Last updated
- 2020-11-15
- Certified
- 2020-11-15
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.