Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jerome Alexander-Terrell Jackson

Individual provider Child Mental Illness Respite Care · NPI 1740815497

Jerome Alexander-Terrell Jackson is a Child Mental Illness Respite Care in Peoria, Arizona. Practices as a sole proprietor. Licensed in Arizona.

Licensed in
AZ
In the registry since
2020
Specialties on file
2
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Practice location Address checks out

9680 W Northern Ave Unit 2311
Peoria, AZ 85345-4655
Phone: (989) 980-8286
Fax: (602) 455-4626
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Foster Care Agency (primary) Taxonomy 253J00000X · Licence 10195508 (AZ)
Child Mental Illness Respite Care Taxonomy 385HR2055X · Licence 10195508 (AZ)

Record details

NPI number1740815497
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMarch 3, 2020
Last updated in NPPESMarch 3, 2020
Certification dateMarch 3, 2020
Mailing address9680 W Northern Ave Unit 2311, Peoria, AZ 85345-4655

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