MARTINA SHAUNTAE JACKSON (NPI# 1871114215) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871114215 |
| Entity Type | Individual |
| Full Name | MARTINA SHAUNTAE JACKSON |
| Practice Address |
2008 N Lawler Ave Chicago IL 60639-3136 |
| Practice Telephone | 7088601201 |
| Practice Fax Number | 7082216679 |
| Mailing Telephone | 7088601201 |
| Mailing Fax Number | 7082216679 |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2020-04-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
178.014194 | IL | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | LICENSED PROFESSIONAL COUNSELOR | 178.014194 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326578501 | Martina S Jackson | Counselor | 331 Main St, Norwich, CT 06360-5836 | 2017-06-19 |
| 1982058244 | Martina Jackson | Counselor | 1909 Cheker Sq, East Hazel Crest, IL 60429-1442 | 2016-04-22 |
| 1346529831 | Martina A. Jackson | Registered Nurse | 201 N Burhans Blvd, Hagerstown, MD 21740-4677 | 2011-08-15 |
| Street Address |
2008 N LAWLER AVE |
| City | CHICAGO |
| State | IL |
| Zip Code | 60639-3136 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376102814 | Rl Group | Clinical Nurse Specialist | 2008 N Lawler Ave, Chicago, IL 60639-3136 | 2019-06-09 |
| 1003437450 | Adriana J Butcher | Counselor | 2008 N Lawler Ave, Chicago, IL 60639-3136 | 2020-04-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881293801 | Wh Il Dental Pllc | Dentist | 18086 N. Kilpatrick Ave., Chicago, IL 60639 | 2020-10-21 |
| 1568012375 | Ellen E Cox | Physical Therapist | 4369 W Diversey Ave, Chicago, IL 60639 | 2019-09-13 |
| 1306379268 | Michael Duarte | Family Medicine | 4417 W Diversey Ave, Chicago, IL 60639 | 2017-04-07 |
| 1013464593 | Ismile Dental | Dentist | 4953 West Fullerton Ave, Chicago, IL 60639 | 2016-09-01 |
| 1952773566 | Flor Cortes | Pharmacist | 4626 W Diversey, Chicago, IL 60639 | 2015-10-22 |
| 1205178654 | The Head Injury Center for Prevention and Community | Case Management | 1732 N. Narragansett Ave, Chicago, IL 60639 | 2013-03-25 |
| 1013299262 | Aamer Arboleda | Pharmacist | 1606 N. Mobile Ave., Chicago, IL 60639 | 2011-09-14 |
| 1295037927 | Mary Veronica Galiotto | Pharmacist | 2920 N Narragansett, Chicago, IL 60639 | 2010-12-01 |
| 1295067478 | Galileo Optical Co. | Eyewear Supplier (Equipment, not the service) | 5759 W. Fullerton, Chicago, IL 60639 | 2010-02-12 |
| 1831424548 | Sonrisa Family Dental At The Hall, P.C. | Dentist | 4608 A & B West Diversey Avenue, Chicago, IL 60639 | 2009-10-14 |
| Find all providers in zip 60639 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609477579 | Shantrell Patrice Sutton | Counselor | 5042 W Erie St, Chicago, IL 60644-1604 | 2020-11-05 |
| 1073114591 | Alternative Schools Network | Counselor | 1807 W Sunnyside Ave, Chicago, IL 60640-5898 | 2020-11-02 |
| 1992306518 | Gravity and Grace Psychotherapy, Pllc | Counselor | 1305 S Michigan Ave Apt 602, Chicago, IL 60605-3398 | 2020-11-02 |
| 1811597263 | April Wilburne | Counselor | 804 E 54th St Apt 3, Chicago, IL 60615-4972 | 2020-10-27 |
| 1043810393 | Pamela Kranyak | Counselor | 30 N Michigan Ave Ste 925, Chicago, IL 60602-3463 | 2020-10-27 |
| 1003413378 | Erika Aguirre | Counselor | 5040 S Keating Ave., Chicago, IL 60632-4919 | 2020-10-08 |
| 1497361661 | Michael V Biederman | Counselor | 4254 N Mozart St Apt 2s, Chicago, IL 60618-1784 | 2020-09-22 |
| 1013523984 | Antionette Fisher | Counselor | 5703 S Peoria St, Chicago, IL 60621-2262 | 2020-09-16 |
| 1114532561 | Nefesh Counseling, LLC | Counselor | 3320 W Foster Ave # 124, Chicago, IL 60625-4813 | 2020-09-12 |
| 1114531043 | Katherine E Evans | Counselor | 1528 W Jonquil Ter Unit 2c, Chicago, IL 60626-5932 | 2020-09-08 |
| 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.