Shannon L Jackson, MSW, LICSW, LADC is a medicare enrolled "Social Worker - Clinical" provider in Duluth, Minnesota. She graduated from healthcare school in 2022 and has 4 years of diverse experience with area of expertise as Clinical Social Worker. She is a member of the group practice Human Development Center and her current practice location is
120 W 2nd St, Duluth, Minnesota. You can reach out to her office (for appointments etc.) via phone at
(218) 728-4491.
Shannon L Jackson is licensed to practice in Minnesota (license number 31007) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1194615336.
Healthcare Provider's Profile
| Full Name | Shannon L Jackson |
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| Gender | Female |
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| Speciality | Clinical Social Worker |
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| Experience | 4 Years |
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| Location | 120 W 2nd St, Duluth, Minnesota |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Shannon L Jackson graduated from medical school in 2022
NPI Data:
- NPI Number: 1194615336
- Provider Enumeration Date: 07/08/2025
- Last Update Date: 07/08/2025
Medicare PECOS Information:
- PECOS PAC ID: 6800304395
- Enrollment ID: I20250805003208
Medical Identifiers
Medical identifiers for Shannon L Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1194615336 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 304733 (Minnesota) | Secondary |
| 1041C0700X | Social Worker - Clinical | 31007 (Minnesota) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Human Development Center | 2961485909 | 39 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Shannon L Jackson allows following entities to bill medicare on her behalf.
| Entity Name | Human Development Center |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1194790733
PECOS PAC ID: 2961485909
Enrollment ID: O20040610000602 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Shannon L Jackson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Shannon L Jackson, MSW, LICSW, LADC
1401 East 1st Street,
Duluth, MN 55805
Ph: (218) 728-4491 | Shannon L Jackson, MSW, LICSW, LADC
120 W 2nd St,
Duluth, MN 55802-2017
Ph: (218) 728-4491 |
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