{"npi":"1720202500","type":"NPI-2","status":"active","name":{"display":"C Wesley Jackson Jr PHD INC","other":[],"organization_name":"C WESLEY JACKSON JR PHD INC","authorised_official":"C Jackson"},"specialty":{"primary_taxonomy":"103TC0700X","primary_taxonomy_description":"Clinical Psychologist","slug":"clinical-psychologist","schema_org_specialty":null,"all":[{"code":"103TC0700X","description":"Clinical Psychologist","primary":false,"state":"MI","license":"000519"},{"code":"103TC0700X","description":"Clinical Psychologist","primary":true,"state":"OH","license":"474"}]},"addresses":[{"purpose":"LOCATION","street_1":"2980 WASHINGTON BLVD","city":"CLEVELAND HEIGHTS","state":"OH","postal_code":"441182450","country_code":"US","phone":"2163219355","fax":"2169323341"},{"purpose":"MAILING","street_1":"2980 WASHINGTON BLVD","city":"CLEVELAND HEIGHTS","state":"OH","postal_code":"441182450","country_code":"US","phone":"2163219355","fax":"2169323341"}],"license":{"state":"OH","number":"474"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"0253309","state":"OH","issuer":null}],"pecos":{"enrolled_at":null,"enrollments":[]},"enumeration_date":"2007-04-12","last_updated":"2012-07-30","_meta":{"source":"NPPES","snapshot_date":"2012-07-30","doc_url":"https://findmynpi.com/api"}}