Provider Type Icon

DR. KENNETH JACKSON PH.D. NPI 1588762108


NPI Information

NPI: 1588762108
Provider Name: DR. KENNETH JACKSON, PH.D.
Classification: Psychologist - 103TC0700X
Entity Type: Individual

Specialization: Clinical

PECOS Registration: Yes

Address:
5701 N ASHLAND AVE
SUITE 205-A
CHICAGO, IL
ZIP 60660
Phone: (773) 454-7202
Get Directions

DR. Kenneth Jackson, PH.D. is a clinical psychologist in Chicago, IL. The provider is a psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems. DR. Kenneth Jackson, PH.D. NPI is 1588762108. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

5701 N ASHLAND AVE
SUITE 205-A
CHICAGO, IL
ZIP 60660-027
Phone: (773) 454-7202
Fax: (773) 465-5041

The NPI 1588762108 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 9/20/2006 and was last updated on 11/4/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1103TH0100XPsychologistHealth Service20042218AINDIANANo
2103TC0700XPsychologistClinical071007090ILLINOISYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.