MR. KURT H JACKSON


Address: 8044 S Racine Ave, Chicago, IL 60620-3011
Phone: 7737239291

MR. KURT H JACKSON (NPI# 1104178649) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1104178649
Entity Type Individual
Full Name MR. KURT H JACKSON
Practice Address 8044 S Racine Ave
Chicago
IL 60620-3011
Mailing Address 2922 Chayes Park Dr
Homewood
IL 60430-2907
Practice Telephone 7737239291
Practice Fax Number 7737239291
Mailing Telephone 7082890203
Mailing Fax Number 7737239291
Enumeration Date 2012-10-08
Last Update Date 2012-10-08
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 101YP2500X Counselor
Specialization: Professional
178006138 IL Behavioral Health & Social Service Providers

Other Providers KURT JACKSON

NPI Name Taxonomy Address Enumeration
1619161858 Kurt T Jackson Ophthalmology 1255 Broad St Ste 104, Bloomfield, NJ 07003-3061 2007-08-30

Office Location

Street Address 8044 S RACINE AVE
City CHICAGO
State IL
Zip Code 60620-3011

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Taxonomy Information

Taxonomy Code 101YP2500X
Grouping Behavioral Health & Social Service Providers
Classification Counselor
Specialization Professional

Taxonomy Definition

Definition to come...

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Competitor

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City CHICAGO
Zip Code 60620

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Dataset Information

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.

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