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Individual
KELLY JACKSON
Active
Individual
KELLY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
194356
OH
171400000X
Health & Wellness Coach
—
—
172V00000X
Community Health Worker
003131
OH
251B00000X
Case Management Agency
—
OH
Other
Enumeration date
10/21/2025
Last updated
05/19/2026
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