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DOMINIQUE SHAVANTA JACKSON
NPI 1689426793
Peer Specialist in Cleveland, OH

Active since April 02, 2024
4114 E 141ST ST, CLEVELAND, OH 44128(216) 501-3289 Get Directions Write a Review

NPPES record last updated: December 2, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 2, 2024, Apr 2, 2024 (2 updates tracked since 2024).

About Dominique Shavanta Jackson NPPES

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

DOMINIQUE SHAVANTA JACKSON (NPI 1689426793) is an individual peer specialist in Cleveland, Ohio, licensed in Ohio (APS.005574) and active in the NPI registry since April 2024.

NPPES Registry Identity

NPI1689426793
Entity TypeIndividualFemale
Primary Taxonomy175T00000X
Provider Legal NameDOMINIQUE SHAVANTA JACKSON
Location Address4114 E 141ST STCleveland, OH 44128-1806
Mailing Address4114 E 141st StCleveland, OH 44128-1806 · (216) 501-3289
Phone(216) 501-3289
Sole ProprietorYes
Enumeration DateApril 2, 2024
Last NPPES UpdateDecember 2, 20242 updates tracked since enumeration
NPPES CertifiedDecember 2, 2024
✔ NPI 1689426793 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyPeer SpecialistOther Service Providers
Taxonomy Code175T00000X
License✔ Licensed in OH · APS.005574
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
Also ListedCase Manager/Care CoordinatorTaxonomy 171M00000X
Also ListedAdult CompanionTaxonomy 372600000X
Also ListedNurse's AideTaxonomy 376K00000X
4114 E 141ST ST, Cleveland, OH 44128
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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 Dominique Jackson's NPI number?

The NPI number for Dominique Jackson is 1689426793. It was assigned to this individual provider in the NPPES registry on April 2, 2024.

Where is Dominique Jackson located?

Dominique Jackson practices at 4114 E 141st St, Cleveland, OH 44128. The listed phone number is (216) 501-3289.

What is Dominique Jackson's specialty?

The primary specialty registered for this NPI is Peer Specialist with taxonomy code 175T00000X.

When was this NPI record last updated?

The NPPES record for Dominique Jackson was last updated on December 2, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months 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.