KELLYN JACKSON (NPI# 1073138194) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073138194 |
| Entity Type | Individual |
| Full Name | KELLYN JACKSON |
| Credential | MA, R-DMT |
| Practice Address |
2310 W Roosevelt Rd Chicago IL 60608-1131 |
| Mailing Address |
2143 W Belmont Ave Apt 3r Chicago IL 60618-6480 |
| Practice Telephone | 3124391552 |
| Mailing Telephone | 8476245298 |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2020-06-15 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225600000X | Dance Therapist | R-DMT-2538 | IL | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
2310 W ROOSEVELT RD |
| City | CHICAGO |
| State | IL |
| Zip Code | 60608-1131 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295751212 | The Board of Trustees of The University of Illinois | Clinic/Center | 2310 W Roosevelt Rd, Chicago, IL 60608-1131 | 2006-07-14 |
| 1891308151 | Mayra Diaz | Student in an Organized Health Care Education/Training Program | 2310 W Roosevelt Rd, Chicago, IL 60608-1131 | 2020-08-26 |
| 1437762630 | Griselda Manzo | Counselor | 2310 W Roosevelt Rd, Chicago, IL 60608-1131 | 2020-08-26 |
| 1225640139 | Juan Miguel Torres | Counselor | 2310 W Roosevelt Rd, Chicago, IL 60608-1131 | 2020-08-21 |
| 1669099727 | Jordan Nicole Reilly | Counselor | 2310 W Roosevelt Rd, Chicago, IL 60608-1131 | 2020-07-06 |
| 1013534353 | Kaitlin Rae Deblasio | Counselor | 2310 W Roosevelt Rd, Chicago, IL 60608-1131 | 2020-07-02 |
| 1467079848 | Anne Bardo | Social Worker | 2310 W Roosevelt Rd, Chicago, IL 60608-1131 | 2020-07-01 |
| 1851949051 | Lauren Michelle Reisman | Counselor | 2310 W Roosevelt Rd, Chicago, IL 60608-1131 | 2019-08-30 |
| 1043867807 | Felipa Roman | Social Worker | 2310 W Roosevelt Rd, Chicago, IL 60608-1131 | 2019-08-26 |
| 1962056994 | Nora Martinez | Social Worker | 2310 W Roosevelt Rd, Chicago, IL 60608-1131 | 2019-07-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699390047 | Bethuna Shields | Occupational Therapist | 1401 South California Ave, Chicago, IL 60608 | 2020-06-11 |
| 1861024176 | Mount Sinai Community Foundation | Clinic/Center | 1414 S Fairfield, Chicago, IL 60608 | 2020-02-05 |
| 1205481058 | Joshua Hartman | Pharmacist | 345 Csb Mc 884, 840 S. Wood St, Chicago, IL 60608 | 2019-08-08 |
| 1194386706 | Mount Sinai Hospital, Chicago | Internal Medicine | Mount Sinai Hospital, 1500 S Fairfield Ave, Chicago, IL 60608 | 2019-06-25 |
| 1841754256 | Julia Bates | Occupational Therapist | 1640 W. Roosevelt Rd., 415 Dhsp (mc 726), Chicago, IL 60608 | 2019-01-30 |
| 1194205781 | Anais J Robles | Contractor | 1626 S Allport St, Chicago, IL 60608 | 2018-08-14 |
| 1114412970 | Dmitri Zbarsky | Internal Medicine | 1500 South Fairfield Ave., F-914, Chicago, IL 60608 | 2018-06-25 |
| 1740773050 | Alexia Ilian Derma Salazar | Speech-Language Pathologist | 2301 W 19th St - 3rd Floor Rear, Chicago, IL 60608 | 2018-06-11 |
| 1912424730 | Pareen Modi | Pharmacist | 2539 South Western Avenue, Chicago, IL 60608 | 2017-08-23 |
| 1952824302 | Raquel Gonzalez Heredia | Surgery | 1500 South Fairfield Ave, Chicago, IL 60608 | 2017-07-18 |
| Find all providers in zip 60608 | ||||
| Taxonomy Code | 225600000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Dance Therapist |
| The dance therapist, sometimes called a movement therapist, focuses on rhythmic body movements as a medium of physical and psychological change. Dance therapy is practiced more often with mental health patients than with physically disabled patients. A master’s degree is required by the American Dance Therapy Association to award the credentials Dance Therapist Registered (DTR). |
| Notes: Source: Joel A. DeLisa and Bruce M. Gans, Rehabilitation Medicine: Principles and Practice Second Edition, J.B. Lippincott Company, Philadelphia: 1993, p. 11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568098606 | Emma Kate Mamis | Dance Therapist | 4350 N Broadway St Ste 2, Chicago, IL 60613-6043 | 2020-03-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437360013 | Luv Joy Seamon | Dance Therapist | 2008 Dempster St, Evanston, IL 60202-1017 | 2007-05-24 |
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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.