Provider Demographics
NPI:1992501332
Name:JACKSON, DANA G (RBT)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:G
Last Name:JACKSON
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 ARROWHEAD DR APT 1B
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-4952
Mailing Address - Country:US
Mailing Address - Phone:219-455-5963
Mailing Address - Fax:
Practice Address - Street 1:205 W FRANCISCAN DR
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4802
Practice Address - Country:US
Practice Address - Phone:888-419-2576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician