MS. IDA B JACKSON LCPC NPI 1659682037

NPI Information

NPI: 1659682037
Provider Name: MS. IDA B JACKSON, LCPC,
Classification: Counselor - 101YM0800X
Entity Type: Individual

Specialization: Mental Health

Address:
4314 S COTTAGE GROVE AVE
SUITE 208
CHICAGO, IL
ZIP 60653
Phone: (312) 747-0036
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MS. Ida B Jackson, LCPC, is a mental health counselor in Chicago, IL. MS. Ida B Jackson, LCPC, NPI is 1659682037. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

4314 S COTTAGE GROVE AVE
SUITE 208
CHICAGO, IL
ZIP 60653-514
Phone: (312) 747-0036
Fax: (312) 747-2208

The enumeration date for this NPI number is 6/30/2010 and was last updated on 6/30/2010.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YM0800X	Counselor	Mental Health	180-000225	ILLINOIS	Yes

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: 11/14/2023

NPI Synchronization or Removal

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