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).
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 |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 101YM0800X |
Counselor Specialization: Mental Health |
180-000225 | IL | Behavioral Health & Social Service Providers |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1356985444 | Ida Jackson | Case Manager/Care Coordinator | 2808 Evangeline St, Monroe, LA 71201-3750 | 2019-10-31 |
Street Address |
4314 S COTTAGE GROVE AVE SUITE 208 |
City | CHICAGO |
State | IL |
Zip Code | 60653-3514 |
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 |
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 |
Find all providers in zip 60653 |
Taxonomy Code | 101YM0800X |
Grouping | Behavioral Health & Social Service Providers |
Classification | Counselor |
Specialization | Mental Health |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1730780602 | Saba Aqel | Counselor | 107 W Van Buren St Ste 215, Chicago, IL 60605-1054 | 2020-11-05 |
1538768155 | Angelicare LLC | Counselor | 6650 N Northwest Hwy Ste 215, Chicago, IL 60631-1363 | 2020-10-23 |
1013516145 | Modern Soul Therapy LLC | Counselor | 2000 N Racine Ave Ste 2160, Chicago, IL 60614-4045 | 2020-10-20 |
1477151942 | Mansukh Sandhu | Counselor | 8765 W Higgins Rd Ste 450, Chicago, IL 60631-4172 | 2020-10-15 |
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 |
1184231672 | Francesca Cottone | Counselor | 1616 N Nordica Ave, Chicago, IL 60707-4317 | 2020-09-28 |
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 |
Find all providers in CHICAGO |
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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.