Provider Demographics
NPI:1194342436
Name:JACKSON, SARA (LSCSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:SISSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7129 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114
Mailing Address - Country:US
Mailing Address - Phone:816-589-8719
Mailing Address - Fax:
Practice Address - Street 1:4810 STATE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-1748
Practice Address - Country:US
Practice Address - Phone:816-221-0305
Practice Address - Fax:816-221-9121
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCAC00802101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)