MS. IDA B JACKSON


Address: 4314 S Cottage Grove Ave, Suite 208, Chicago, IL 60653-3514
Phone: 3127470036

MS. IDA B JACKSON (NPI# 1659682037) 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) 1659682037
Entity Type Individual
Full Name MS. IDA B JACKSON
Credential LCPC,
Practice Address 4314 S Cottage Grove Ave
Suite 208
Chicago
IL 60653-3514
Practice Telephone 3127470036
Practice Fax Number 3127472208
Mailing Telephone 3127470036
Mailing Fax Number 3127472208
Enumeration Date 2010-06-30
Last Update Date 2010-06-30
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 101YM0800X Counselor
Specialization: Mental Health
180-000225 IL Behavioral Health & Social Service Providers

Other Providers IDA JACKSON

NPI Name Taxonomy Address Enumeration
1356985444 Ida Jackson Case Manager/Care Coordinator 2808 Evangeline St, Monroe, LA 71201-3750 2019-10-31

Office Location

Street Address 4314 S COTTAGE GROVE AVE
SUITE 208
City CHICAGO
State IL
Zip Code 60653-3514

Providers in the same location

NPI Name Taxonomy Address Enumeration
1275525412 Chicago Department of Public Health Clinic/Center 4314 S Cottage Grove Ave, Greater Grand Mental Health Center, Chicago, IL 60653-3514 2005-08-15
1265908636 Laurel Beth Goldman Counselor 4314 S Cottage Grove Ave, Chicago, IL 60653-3514 2018-10-23
1083058812 Eric Daniel Lindquist Counselor 4314 S Cottage Grove Ave, Chicago, IL 60653-3514 2013-04-23
1245581743 Latrelle Lowe Kerney Counselor 4314 S Cottage Grove Ave, Suite 208, Chicago, IL 60653-3514 2012-09-24
1790096667 Catherine House Counselor 4314 S Cottage Grove Ave, Suite 208, Chicago, IL 60653-3514 2010-06-25
1356662977 Charles Hayes Counselor 4314 S Cottage Grove Ave, Room 208, Chicago, IL 60653-3514 2010-06-17

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1881215804 Pamela Ann Brazelton-sykes Counselor Pioneer Gardens Supportive Living, 3800 S King Dr, Chicago, IL 60653 2020-04-30
1962915439 Pickup Transport Lllp Non-emergency Medical Transport (VAN) 4418 S. Oakenwald Ave, Chicago, IL 60653 2017-11-07
1245758309 Qi Wellness LLC Case Management 525 E 46th Place, Chicago, IL 60653 2017-09-08
1598202897 Fadesire O Ajuwon Registered Nurse 4218 S King Dr, 1n, Chicago, IL 60653 2017-01-24
1013464619 Roundys Supermarkets Inc Pharmacy 3857 S Dr Martin Luther King Jr Dr, Chicago, IL 60653 2016-09-01
1417384793 Griffin Orthodontics PC Dentist 1040 E 47th Street, Chicago, IL 60653 2013-10-02
1114350659 Carita Dale Johnson Pharmacist 3753 S. Cottage Grove Ave, 104, Chicago, IL 60653 2013-08-20
1245677848 Mercy Diagnostic and Treatment Center Clinic/Center 3755 S Cottage Grove, Chicago, IL 60653 2013-05-23
1952745937 Mercy Community Pharmacy At Oakwood Shores Pharmacy 3753 S. Cottage Grove, Chicago, IL 60653 2013-04-22
1386952315 Jami S Little Developmental Therapist 617 East 41st, Chicago, IL 60653 2010-09-24
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Taxonomy Information

Taxonomy Code 101YM0800X
Grouping Behavioral Health & Social Service Providers
Classification Counselor
Specialization Mental Health

Taxonomy Definition

Definition to come...

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NPI Name Taxonomy Address Enumeration
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1881291920 Freddy Reyes Counselor 931 W Leland Ave Apt 405, Chicago, IL 60640-6611 2020-10-01
1508463704 Tynisha Jointer Counselor 7710 S Saint Lawrence Ave, Chicago, IL 60619-2925 2020-10-01
1851908206 Manqual Chambers Counselor 2801 S King Dr, Chicago, IL 60616-2949 2020-09-29
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1952916322 Elle Skelton Counselor 2219 N Seeley Ave Apt 3f, Chicago, IL 60647-3363 2020-09-13
1437764305 Donita M Lester Counselor 7022 S South Shore Dr Apt 214, Chicago, IL 60649-2229 2020-09-09
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Competitor

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City CHICAGO
Zip Code 60653

Improve Information

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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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