MARTINA SHAUNTAE JACKSON NPI 1871114215

NPI Information

NPI: 1871114215
Provider Name: MARTINA SHAUNTAE JACKSON
Classification: Counselor - 101YP2500X
Entity Type: Individual

Specialization: Professional

Address:
2008 N LAWLER AVE
CHICAGO, IL
ZIP 60639
Phone: (708) 860-1201
Get Directions

Martina Shauntae Jackson is a professional counselor in Chicago, IL. Martina Shauntae Jackson NPI is 1871114215. 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:

2008 N LAWLER AVE
CHICAGO, IL
ZIP 60639-136
Phone: (708) 860-1201
Fax: (708) 221-6679

The enumeration date for this NPI number is 4/27/2020 and was last updated on 4/27/2020.

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	101YP2500X	Counselor	Professional	178.014194	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	178.014194	OTHER	ILLINOIS	LICENSED PROFESSIONAL COUNSELOR

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

NPI Synchronization or Removal

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