TAWANN JACKSON (NPI# 1710404496) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710404496 |
| Entity Type | Individual |
| Full Name | TAWANN JACKSON |
| Credential | ED.S, NCSP |
| Practice Address |
360 Blair Lane Door 13 Bolingbrook IL 60615 |
| Mailing Address |
360 Blair Lane Door 13 Bolingbrook IL 60440 |
| Practice Telephone | 6306791210 |
| Mailing Telephone | 6306791210 |
| Enumeration Date | 2017-08-24 |
| Last Update Date | 2017-08-24 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TS0200X |
Psychologist Specialization: School |
2403396 | IL | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164634507 | Tawann Patrice Jackson | Dentist | 650 Pennsylvania Ave Se, Suite 460, Washington, DC 20003-4318 | 2007-05-06 |
| Street Address |
360 BLAIR LANE DOOR 13 |
| City | BOLINGBROOK |
| State | IL |
| Zip Code | 60615 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578170221 | Cook County | Technician, Other | 430 East 51st Pl, Chicago, IL 60615 | 2020-09-28 |
| 1700498326 | Connie Frances Davis | Massage Therapist | 5481 S. Cornell, Chicago, IL 60615 | 2020-08-17 |
| 1134781974 | Lifestyle Rejuvenation Medical Group Pllc | Chiropractor | 1740 E 55th Street, Chicago, IL 60615 | 2019-07-02 |
| 1275007767 | Michelle Alyse Costello | Social Worker | 1225 E 53rd St, Suite 606, Chicago, IL 60615 | 2019-01-17 |
| 1194207522 | Cindy Louise Lys | Social Worker | 1525 E 53rd Street Suite 516-4, Chicago, IL 60615 | 2018-09-01 |
| 1861983660 | Pranusha Pinna | Student in an Organized Health Care Education/Training Program | 1850 W. Harrison St., Chicago, IL 60615 | 2018-05-29 |
| 1528577632 | Jonah Waseberg | Counselor | 1100 E.55th St, Chicago, IL 60615 | 2017-09-21 |
| 1194259069 | Molly Kachale Netter | Nurse Practitioner | 1554 E 55th St., Chicago, IL 60615 | 2017-04-17 |
| 1205387990 | Kirk Remon Riddle | Counselor | 1525 E. 53rd Street, Suite 425, Chicago, IL 60615 | 2016-10-18 |
| 1326598319 | Highland Park Cvs, L.L.C. | Durable Medical Equipment & Medical Supplies | 1346 E 53rd St., Chicago, IL 60615 | 2016-10-13 |
| Find all providers in zip 60615 | ||||
| Taxonomy Code | 103TS0200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | School |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013423847 | Vincent Miller | Psychologist | 200 Recreation Dr, Bolingbrook, IL 60440-3071 | 2017-12-15 |
| 1063921054 | Maria Teresa Ramos | Psychologist | 350 Blair Ln, Bolingbrook, IL 60440-1801 | 2017-09-22 |
| 1396262986 | Dena R Hasselberg | Psychologist | 905 Lily Cache Ln, Bolingbrook, IL 60440-3100 | 2017-08-24 |
| 1588181408 | Tristan Harter | Psychologist | 197 Winston Dr, Bolingbrook, IL 60440-1300 | 2017-08-23 |
| 1679099709 | Wendy Fullmer | Psychologist | 179 Commonwealth Dr, Bolingbrook, IL 60440-1600 | 2017-08-21 |
| 1770009805 | Nancy Blume | Psychologist | 777 Falcon Ridge Way, Bolingbrook, IL 60440-2200 | 2017-08-21 |
| 1073039350 | Jennifer Ann Mamak | Psychologist | 1470 Raven Dr, Bolingbrook, IL 60490-4510 | 2017-08-17 |
| 1972110559 | Lindsey Renfro | Psychologist | 150 N Schmidt Rd, Bolingbrook, IL 60440-2689 | 2020-09-28 |
| 1982241212 | Jessica Dawn Wainer | Psychologist | 150 N Schmidt Rd, Bolingbrook, IL 60440-2689 | 2019-12-05 |
| 1861042947 | Jennifer Rose Frankowicz | Psychologist | 777 Falcon Ridge Way, Bolingbrook, IL 60440-2200 | 2019-09-19 |
| Find all providers in BOLINGBROOK | ||||
| City | BOLINGBROOK |
| Zip Code | 60615 |
Please comment or provide details below to improve the information on TAWANN JACKSON.
| 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.