Willie Jackson
Willie Jackson is a Rehabilitation Clinic/Center in Mesa, Arizona. Practices as a sole proprietor. Licensed in Arizona.
- Licensed in
- AZ
- In the registry since
- 2024
- Specialties on file
- 3
Practice location Address checks out
400 N PimaMesa, AZ 85201-5907
Phone: (602) 551-0659
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Intellectual and/or Developmental Disabilities Residential Treatment Facility (primary) | Taxonomy 320600000X |
|---|---|
| Rehabilitation Clinic/Center | Taxonomy 261QR0400X · Licence 23683875 (AZ) |
| Behavior Technician | Taxonomy 106S00000X (AZ) |
Record details
| NPI number | 1144061649 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | Yes |
| NPI enumerated | June 6, 2024 |
| Last updated in NPPES | January 30, 2026 |
| Certification date | January 30, 2026 |
| Mailing address | 6410 S 58th Ave, Laveen, AZ 85339-2262 |
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