WILLIE MAE JACKSON (NPI# 1043312960) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043312960 |
| Entity Type | Individual |
| Full Name | WILLIE MAE JACKSON |
| Practice Address |
820 S Damen Ave Chicago IL 60612-3728 |
| Practice Telephone | 3125693565 |
| Practice Fax Number | 3125696118 |
| Mailing Telephone | 3125693565 |
| Mailing Fax Number | 3125696118 |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 136A00000X | Dietetic Technician, Registered | Dietary & Nutritional Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841571478 | Willie Pearl Jackson | Behavioral Analyst | 5304 Roseland Ave, Las Vegas, NV 89130-2635 | 2011-09-09 |
| 1013143395 | Willie Lee Jackson Jr. | Counselor | 157 Santa Barbara Plz, Los Angeles, CA 90008-2508 | 2009-06-01 |
| 1073754065 | Willie Mae Jackson | Psychiatry & Neurology | 2211 Mayfair Dr, Suite 409, Owensboro, KY 42301-4568 | 2009-03-20 |
| 1477687598 | Willie Jackson | Social Worker | 660 Park St, Jacksonville, FL 32204-2933 | 2007-03-14 |
| 1447349436 | Willie D Jackson | Counselor | 11301 Wilshire Blvd, Bldg 206 Room 24, Los Angeles, CA 90073-1003 | 2006-10-11 |
| Street Address |
820 S DAMEN AVE |
| City | CHICAGO |
| State | IL |
| Zip Code | 60612-3728 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679561260 | Jesse Brown Veterans Administration Hospital | General Acute Care Hospital | 820 S Damen Ave, Chicago, IL 60612-3728 | 2005-10-09 |
| 1528678463 | Jennifer Lee | Pharmacist | 820 S Damen Ave, Chicago, IL 60612-3728 | 2020-08-05 |
| 1770101115 | Natalia Irena Szynalik | Pharmacist | 820 S Damen Ave, Chicago, IL 60612-3728 | 2020-07-13 |
| 1568088706 | Benjamin Galloway | Podiatrist | 820 S Damen Ave, Chicago, IL 60612-3728 | 2020-06-23 |
| 1588280937 | Laine Ferrill | Pharmacist | 820 S Damen Ave, Chicago, IL 60612-3728 | 2020-06-22 |
| 1598380560 | Regan Kelley | Speech-Language Pathologist | 820 S Damen Ave, Chicago, IL 60612-3728 | 2020-06-15 |
| 1609490531 | Jacob Conditt | Student in an Organized Health Care Education/Training Program | 820 S Damen Ave, Chicago, IL 60612-3728 | 2020-06-06 |
| 1023632551 | Stephen Macrowski | Dentist | 820 S Damen Ave, Chicago, IL 60612-3728 | 2020-06-01 |
| 1588286256 | Nisha Utpal Patel | Dentist | 820 S Damen Ave, Chicago, IL 60612-3728 | 2020-05-15 |
| 1568084804 | Tuhin Mukherjee | Podiatrist | 820 S Damen Ave, Chicago, IL 60612-3728 | 2020-05-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144839739 | Sandhya Shri Kannayiram | Internal Medicine | 1901w Harrison Street, Chicago, IL 60612 | 2020-07-29 |
| 1568080174 | Nastaran Ordoyo Haghani Rad | Student in an Organized Health Care Education/Training Program | 1950 W. Polk Street, Room 6203, Chicago, IL 60612 | 2020-07-09 |
| 1669090403 | Marianne Gagnon-konamna | Student in an Organized Health Care Education/Training Program | 1950 West Polk Street, Chicago, IL 60612 | 2020-07-08 |
| 1922625672 | Tanya Montgomery Nee Brown | Pediatrics | 1950 West Polk Street, Neonatal and Perinatal Department, Chicago, IL 60612 | 2020-06-29 |
| 1124643028 | Ashley Swan | Dentist | 801 S. Paulina St, Uic College of Dentistry - Endodontics Clinic, Chicago, IL 60612 | 2020-06-16 |
| 1831711381 | Baillie Anne Bronner | Obstetrics & Gynecology | 1653 W Congress Pkwy Chicago, Il 60612, Chicago, IL 60612 | 2020-05-07 |
| 1154942449 | Keisha Davell Cole | Case Manager/Care Coordinator | 612 S Western Ave Unit 1, Chicago, IL 60612 | 2020-04-28 |
| 1275153777 | Isac Lim | Student in an Organized Health Care Education/Training Program | 1234 S. Wells, Chicago, IL 60612 | 2020-04-24 |
| 1578183414 | Zachary Belden | Student in an Organized Health Care Education/Training Program | Uic Psychiatry Residency 912 S. Wood St., Rm 130b Npi-s (mc 913), Chicago, IL 60612 | 2020-04-21 |
| 1548880560 | Christina Nunez | Student in an Organized Health Care Education/Training Program | 801 S. Paulina Street, M/c 850, Chicago, IL 60612 | 2020-04-20 |
| Find all providers in zip 60612 | ||||
| Taxonomy Code | 136A00000X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietetic Technician, Registered |
| A person trained in food and nutrition who is an integral part of health care and foodservice management teams. A dietetic technician, registered (DTR) has successfully completed at least a two-year associate’s degree at a US regionally accredited college or university; a dietetic technician program approved by The American Dietetic Association, including 450 hours of supervised practice experience; a national examination administered by the Commission on Dietetic Registration; and continuing professional educational requirements to maintain registration. |
| Notes: Source: The American Dietetic Association. Becoming a Dietetic Technician, Registered -- a food and nutrition practitioner. Chicago, IL: The American dietetic association, July 1997. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922631316 | Altaira Gil | Dietetic Technician, Registered | 3824 W 69th St, Chicago, IL 60629-4206 | 2020-02-13 |
| 1376157479 | Adriana Bueno | Dietetic Technician, Registered | 225 E Chicago Ave # 59, Chicago, IL 60611-2991 | 2020-09-04 |
| 1669085973 | Octavia Lindsey | Dietetic Technician, Registered | 225 E Chicago Ave, Chicago, IL 60611-2991 | 2020-08-26 |
| 1891123832 | Beloved Community Family Wellness Ctr | Dietetic Technician, Registered | 6821 S Halsted St, Chicago, IL 60621-1833 | 2013-10-30 |
| 1174530331 | Doris Jean Marshall | Dietetic Technician, Registered | 820 S Damen Ave, Chicago, IL 60612-3728 | 2006-08-01 |
| 1639186877 | Valerie Letease Carr | Dietetic Technician, Registered | 820 S Damen Ave, Chicago, IL 60612-3728 | 2006-08-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962767038 | Win U Care for Health | Dietetic Technician, Registered | 321 Big Arch Rd., Godfrey, IL 62035 | 2012-07-05 |
| 1790049831 | Julia Lynn Phillips | Dietetic Technician, Registered | 321 Big Arch Rd, Godfrey, IL 62035 | 2012-07-03 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.