Provider Demographics
NPI:1487169595
Name:JACKSON ILYAS, FELISHA TRANNA (EDD-CI, LMSW, BS)
Entity type:Individual
Prefix:DR
First Name:FELISHA
Middle Name:TRANNA
Last Name:JACKSON ILYAS
Suffix:
Gender:F
Credentials:EDD-CI, LMSW, BS
Other - Prefix:DR
Other - First Name:FELISHA
Other - Middle Name:TRANNA
Other - Last Name:GIBSON(MARRIED) GROSS (MAIDEN)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVENUE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229
Mailing Address - Country:US
Mailing Address - Phone:513-636-4200
Mailing Address - Fax:
Practice Address - Street 1:3333 BURNET AVENUE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229
Practice Address - Country:US
Practice Address - Phone:513-636-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1002121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker