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

Willie Jackson

Individual provider Rehabilitation Clinic/Center · NPI 1144061649

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 Pima
Mesa, AZ 85201-5907
Phone: (602) 551-0659
Show map & directions

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 number1144061649
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJune 6, 2024
Last updated in NPPESJanuary 30, 2026
Certification dateJanuary 30, 2026
Mailing address6410 S 58th Ave, Laveen, AZ 85339-2262

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