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KIM ELAINE JACKSON LICSW
NPI 1184275166
Social Worker - Clinical in Oakland, CA

Active since September 22, 2019PECOS Enrolled
4909 DAVENPORT AVE, OAKLAND, CA 94619(206) 549-4668(206) 568-7043 Get Directions Write a Review

NPPES record last updated: April 3, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 3, 2024, Sep 22, 2019 (2 updates tracked since 2019).

About Kim Elaine Jackson Licsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KIM ELAINE JACKSON LICSW (NPI 1184275166) is an individual clinical provider in Oakland, California, licensed in Washington (LW61326871) and active in the NPI registry since September 2019. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1184275166
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameKIM ELAINE JACKSONCredential: LICSW
Location Address4909 DAVENPORT AVEOakland, CA 94619-2920
Mailing Address1253 C St SeWashington, DC 20003-2202 · (206) 549-4668 · Fax (206) 568-7043
Phone(206) 549-4668
Fax(206) 568-7043
Sole ProprietorNo
Enumeration DateSeptember 22, 2019
Last NPPES UpdateApril 3, 20242 updates tracked since enumeration
NPPES CertifiedApril 3, 2024
✔ NPI 1184275166 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
Licenses✔ Licensed in WA · LW61326871✔ Licensed in DC · LC50082406
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
4909 DAVENPORT AVE, Oakland, CA 94619
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Other Names 1

Professional Name (2)Ms. Kim Elaine Jackson Licsw

Other Identifiers 2

Medicaid2229463DC
Medicaid2229463WA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Harvard Pilgrim Health Care, Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kim Elaine Jackson Licsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 94619 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$0.00 typical visit price
range $69.00 – $202.35
Typical copayment $0.00 (range $17.25 – $50.58)
Most-billed visit code NA
Established Patient
$84.91 typical visit price
range $23.44 – $166.46
Typical copayment $21.22 (range $5.86 – $41.61)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kim Jackson's NPI number?

The NPI number for Kim Jackson is 1184275166. It was assigned to this individual provider in the NPPES registry on September 22, 2019. The provider is also known as Ms. Kim Elaine Jackson Licsw.

Where is Kim Jackson located?

Kim Jackson practices at 4909 Davenport Ave, Oakland, CA 94619. The listed phone number is (206) 549-4668.

What is Kim Jackson's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Kim Jackson enrolled in Medicare?

Yes. Kim Jackson is registered in the Medicare PECOS enrollment system.

What insurance does Kim Jackson accept?

Health plans from Harvard Pilgrim Health Care and Providence Health Plan list Kim Jackson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kim Jackson was last updated on April 3, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.