MRS. JACKIE LOU ANDERSON


Address: 101 Shoreland Rd, Machesney Park, IL 61115-2833
Phone: 8156331173

MRS. JACKIE LOU ANDERSON (NPI# 1295004406) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1295004406
Entity Type Individual
Full Name MRS. JACKIE LOU ANDERSON
Practice Address 101 Shoreland Rd
Machesney Park
IL 61115-2833
Practice Telephone 8156331173
Mailing Telephone 8156331173
Enumeration Date 2011-12-16
Last Update Date 2011-12-16
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 222Q00000X Developmental Therapist IL Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Other Provider Identifier

State Issuer Identifier Type Code
IL EI 222Q00000X 01

Other Providers JACKIE ANDERSON

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1477072437 Jackie Lynn Anderson Social Worker 2116 Broadway, Oakland, CA 94612-2310 2017-09-11
1447789565 Jackie Mae Anderson Emergency Medicine 10800 Knights Rd, Philadelphia, PA 19114-4200 2017-06-12
1790132652 Jackie Anderson Family Medicine 1010 N Kansas St, Wichita, KS 67214-3124 2016-05-20

Office Location

Street Address 101 SHORELAND RD
City MACHESNEY PARK
State IL
Zip Code 61115-2833

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1033675087 Mary B O'meara Nurse Practitioner 9721 N Alpine, Machesney Park, IL 61115 2019-02-14
1518486398 Jordyn Morris Speech-Language Pathologist 710 Ralston Rd, Machesney Park, IL 61115 2017-09-13
1053713966 Dental Professionals of Illinois, P.C. Dentist 1411 W Lane Rd Ste B, Machesney Park, IL 61115 2014-09-23
1922326271 Mitalkumar K Patel Dentist 1363 W. Lane Road, Machesney Park, IL 61115 2010-05-12
1720134802 Luxottica of America Inc. Eyewear Supplier (Equipment, not the service) 1349 W Lane Rd, Machesney Park, IL 61115 2007-01-25
1710371471 Usv Optical Inc. Eyewear Supplier (Equipment, not the service) 1770 W Lane Rd, Machesney, IL 61115 2015-03-20
1225436546 Susan Lynn Sherbon Community/Behavioral Health 251 Brentwood Rd, Machesney Park, IL 61115-1064 2014-12-18
1174872519 Dana Lynn Slabaugh Physical Therapist 10510 Ventura Blvd, Machesney Park, IL 61115-1263 2012-08-30
1073590204 Terry Buzzard Family Medicine 11475 N 2nd St, Machesney Park, IL 61115-1285 2005-12-29
1609475672 Meaghan Elizabeth Reed Physician Assistant 11475 N 2nd St, Machesney Park, IL 61115-1285 2020-10-21
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Taxonomy Information

Taxonomy Code 222Q00000X
Grouping Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Classification Developmental Therapist

Taxonomy Definition

A Developmental Therapist is a person qualified by completion of an approved program in Developmental Therapy and where applicable credentialed by the state and practicing within the scope of the credential, or credentialed by completion of education experiences as approved by the state and practicing within the scope of that credential or, where state credentialing does not exist, certified by the Board of the Developmental Therapy Association. A developmental therapist evaluates children's global development in order to identify areas of developmental delay whether arising from physiological, neurological, or environmental factors, or a combination of factors; and designs, implements, and modifies therapeutic interventions for the child and the family to promote the child's acquisition of skills in a variety of developmental areas, including cognitive processes and social interaction in order to maximize functional independence and developmental homeostasis, and improve the quality of life at home and in the community; and provides consultation for the parents and other professionals working with the family on global development.
Notes: Source: The Illinois Developmental Therapists Association [1/1/2007: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1306455357 Noel Elizabeth Ryall Developmental Therapist 9123 Baldwin Dr, Machesney Park, IL 61115-1715 2020-07-27

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1003413568 Amy Rohan Developmental Therapist 17545 Mulberry Ave, Tinley Park, IL 60487-6163 2020-10-07
1992302954 Vannetta C Thompson Developmental Therapist 2247 Gunderson Ave Apt 2, Berwyn, IL 60402-5147 2020-10-02
1477150506 Quanita Crawford Developmental Therapist 3734 W Cortland St Apt 303, Chicago, IL 60647-7565 2020-10-01
1740897412 Angela Perry Developmental Therapist 521 Eden Park Dr, Rantoul, IL 61866-1507 2020-09-28
1235746975 Dominique Scott Developmental Therapist 5342 S Wells St, Chicago, IL 60609-6219 2020-09-27
1003429820 Adrienne C Latronica Developmental Therapist 9865 Cordoba Ct Apt 2b, Orland Park, IL 60462-3190 2020-08-31
1669083424 Lindsay Miner Developmental Therapist 2272 W Leland Ave # 1e, Chicago, IL 60625-2006 2020-08-13
1851901672 Gretchen Susanne Biggerstaff Developmental Therapist 1706 S Hancock St, Mc Leansboro, IL 62859-1996 2020-08-06
1205446549 Rene Yvonne Green Developmental Therapist 14425 E Blue Ridge Dr, Effingham, IL 62401-7168 2020-08-02
1275141533 Megan Elizabeth Myers Developmental Therapist 407 Brian Dr, Manteno, IL 60950-1651 2020-07-22
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Competitor

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City MACHESNEY PARK
Zip Code 61115

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Dataset Information

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.

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