Provider Demographics
NPI:1851269013
Name:JACKSON, BRISHAUN KIAZ JOSHUA
Entity type:Individual
Prefix:
First Name:BRISHAUN
Middle Name:KIAZ JOSHUA
Last Name:JACKSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 W SAINT CLAIR AVE APT 310
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-1534
Mailing Address - Country:US
Mailing Address - Phone:216-971-0114
Mailing Address - Fax:
Practice Address - Street 1:99 W SAINT CLAIR AVE APT 310
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-1534
Practice Address - Country:US
Practice Address - Phone:216-971-0114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-28
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator