Individual provider · Type 1 NPI

Eboni Shantelle Jackson

Peer Specialist · Cody, WY

NPI number 1265229595 Active

Practice location

707 Sheridan Ave
Cody, WY 82414-3409

Call (307) 578-2486 Map

Fax (307) 578-2247

Other practice locations

  • 125 S Division St, Powell, WY 82435-2409 · (307) 754-7970
  • 507 N Clark St, Powell, WY 82435-1915 · (307) 754-7970

Specialties and licenses

TaxonomyCodeLicense
Peer Specialist Primary 175T00000X190 (WY)

Peer Specialist: 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.

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About NPI 1265229595

Eboni Shantelle Jackson's National Provider Identifier is 1265229595, issued on Apr 21, 2025. The primary taxonomy on file is Peer Specialist (175T00000X), and the practice location is in Cody, WY. The record was last updated on Mar 5, 2026.