Ms Shenelle Jackson, MSW, LCSW is a medicare enrolled "Social Worker - Clinical" provider in Oakland, California. Her current practice location is
3301 E 12th St, Oakland, California. You can reach out to her office (for appointments etc.) via phone at
(510) 269-9030.
Ms Shenelle Jackson is licensed to practice in California (license number ) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1780167437.
Healthcare Provider's Profile
| Full Name | Ms Shenelle Jackson |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 3301 E 12th St, Oakland, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1780167437
- Provider Enumeration Date: 09/10/2018
- Last Update Date: 05/04/2022
Medicare PECOS Information:
- PECOS PAC ID: 1355865684
- Enrollment ID: I20250408003540
Medical Identifiers
Medical identifiers for Ms Shenelle Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1780167437 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101Y00000X | Counselor | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (California) | Primary |
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. Ms Shenelle Jackson allows following entities to bill medicare on her behalf.
| Entity Name | Grow Healthcare Group Pa |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1245845932
PECOS PAC ID: 3476961368
Enrollment ID: O20221213001514 |
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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. Ms Shenelle 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 |
|---|
Ms Shenelle Jackson, MSW, LCSW
4142 E Morada Lane, 2202,
Stockton, CA 95212
Ph: (240) 338-0507 | Ms Shenelle Jackson, MSW, LCSW
3301 E 12th St,
Oakland, CA 94601-3424
Ph: (510) 269-9030 |
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