KRISTA JACKSON (NPI# 1265813596) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265813596 |
| Entity Type | Individual |
| Full Name | KRISTA JACKSON |
| Credential | LCPC |
| Practice Address |
419 Center St Ste C Grayslake IL 60030-1645 |
| Mailing Address |
Po Box 2257 Chesterton IN 46304-0357 |
| Practice Telephone | 8477673540 |
| Mailing Telephone | 2199268320 |
| Mailing Fax Number | 2199263524 |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2015-06-11 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
180003226 | IL | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972933216 | Krista Jackson | Licensed Practical Nurse | 4872 Debbie Dr, Medina, OH 44256-8675 | 2013-11-23 |
| 1457330227 | Krista L. Jackson | Physician Assistant | 5000 Ky Route 321, Suite 2162, Prestonsburg, KY 41653-9113 | 2006-01-11 |
| Street Address |
419 CENTER ST STE C |
| City | GRAYSLAKE |
| State | IL |
| Zip Code | 60030-1645 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245742865 | Neurorehab Psychology Consultants, LLC | Psychologist | 419 Center St Ste C, Grayslake, IL 60030-1645 | 2017-11-05 |
| 1184085573 | Danielle Marie Ciccone- Coutre | Psychologist | 419 Center St Ste C, Grayslake, IL 60030-1645 | 2016-03-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891393781 | Camelot Care Centers, LLC | Clinic/Center | 34121 North Route 45 Suite 207, Grayslake, IL 60030 | 2020-10-13 |
| 1992347892 | Pier London | Social Worker | 18640 Belivdere Rd., Grayslake, IL 60030 | 2019-10-11 |
| 1972156529 | Elizabeth Reeve | Counselor | 18640 Belvidere, Grayslake, IL 60030 | 2019-07-23 |
| 1144725987 | Michael Kraft | Family Medicine | 1475 E. Belvidere Road, Suite 385, Grayslake, IL 60030 | 2018-03-26 |
| 1255850780 | Megan B March | Speech-Language Pathologist | 33089 N Battershall Rd, Grayslake, IL 60030 | 2017-09-15 |
| 1669992665 | Easy Oxygen Inc. | Durable Medical Equipment & Medical Supplies | 1862 E Belvidere Road #125, Grayslake, IL 60030 | 2017-06-21 |
| 1184163628 | Surprenant Chiropractic LLC | Clinic/Center | 1227 N Illinois Route 83, Suite A, Grayslake, IL 60030 | 2017-02-16 |
| 1700230976 | Camelot Care Centers, LLC. | Foster Care Agency | 34121 North Route 45, Suite 207, Grayslake, IL 60030 | 2016-04-14 |
| 1932560414 | Vital Therapeutics Inc | Physical Therapist | 34121 N Us 45, Suite 101, Grayslake, IL 60030 | 2016-03-11 |
| 1093175804 | Zigma Visiting Physician, LLC | General Practice | 4 N Deer Point Dr, 1002, Hainesville, IL 60030 | 2016-03-07 |
| Find all providers in zip 60030 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972156529 | Elizabeth Reeve | Counselor | 18640 Belvidere, Grayslake, IL 60030 | 2019-07-23 |
| 1962816967 | Ronald Ray Bristow | Counselor | 888 E Belvidere Rd, Suite 319, Grayslake, IL 60030-2568 | 2014-06-17 |
| 1376977546 | Megan Blazek | Counselor | 18859 W Maple Ave, Grayslake, IL 60030-2536 | 2013-08-24 |
| 1043570237 | Lisa Raddatz | Counselor | 214 Siwiha Dr, Grayslake, IL 60030-1444 | 2012-05-21 |
| 1831499052 | Eauly Brautigam | Counselor | 18640 Belvidere Road, Grayslake, IL 60030 | 2010-10-22 |
| 1376671727 | Stephanie Russo | Counselor | 18640 W. Belvidere Road, Grayslake, IL 60030 | 2007-02-28 |
| 1568502227 | James M. Veltman | Counselor | 100 N. Atkinson Road, Suite 112-f, Grayslake, IL 60030 | 2007-02-08 |
| 1083672034 | Robert Flynn | Counselor | 205 Commerce Dr Ste C, Grayslake, IL 60030-1646 | 2006-05-01 |
| 1003388034 | Garrison Counseling LLC | Counselor | 205 Commerce Dr Ste C, Grayslake, IL 60030-1646 | 2019-01-02 |
| 1992239396 | Onward Counseling Center | Counselor | 888 E Belvidere Rd, Ste 319, Grayslake, IL 60030-2568 | 2017-04-12 |
| Find all providers in GRAYSLAKE | ||||
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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.