Provider Demographics
NPI:1851198717
Name:JACKSON, ALLISSA RACHEL
Entity type:Individual
Prefix:
First Name:ALLISSA
Middle Name:RACHEL
Last Name:JACKSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 COLETTE DR APT B
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-2286
Mailing Address - Country:US
Mailing Address - Phone:330-414-7331
Mailing Address - Fax:
Practice Address - Street 1:753 COLETTE DR APT B
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-2286
Practice Address - Country:US
Practice Address - Phone:330-414-7331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No251B00000XAgenciesCase Management
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No372600000XNursing Service Related ProvidersAdult Companion
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child