COLLEEN M JACKSON (NPI# 1699317263) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699317263 |
| Entity Type | Individual |
| Full Name | COLLEEN M JACKSON |
| Practice Address |
1136 S Delano Ct W Ste B201 Chicago IL 60605-3734 |
| Mailing Address |
15127 S 73rd Ave Ste G Orland Park IL 60462-3425 |
| Practice Telephone | 7088455500 |
| Practice Fax Number | 7088455505 |
| Mailing Telephone | 7088455500 |
| Mailing Fax Number | 7088455505 |
| Enumeration Date | 2019-10-15 |
| Last Update Date | 2019-10-15 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | 178015305 | IL | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1401 W Hollywood Ave, Chicago, IL 606604214 | 7088455500 | 7088455505 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447762844 | Colleen Jackson | Occupational Therapy Assistant | 8011 Elkhart Ave, Lubbock, TX 79424-2615 | 2017-10-26 |
| 1952765661 | Colleen E Jackson | Clinical Neuropsychologist | 150 S Huntington Ave, Boston Va Medical Center (116b), Boston, MA 02130-4817 | 2016-04-08 |
| 1801269840 | Colleen Q Jackson | Licensed Practical Nurse | 224 Harrison St, Suite 680, Syracuse, NY 13202-3056 | 2015-11-12 |
| 1669629275 | Colleen A Jackson | Nutritionist | 101 Hospital Rd, Patchogue, NY 11772-4870 | 2008-08-26 |
| 1134331259 | Colleen Delores Jackson | Nurse Practitioner | 8700 Beverly Blvd, Thalians 2w, Rm 218, West Hollywood, CA 90048-1804 | 2007-05-03 |
| 1346354073 | Colleen Marie Jackson | Durable Medical Equipment & Medical Supplies | 417 E Baltimore St, Unit A, Taneytown, MD 21787-2300 | 2006-08-19 |
| Street Address |
1136 S DELANO CT W STE B201 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60605-3734 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417254004 | Jalissa Shelby | Counselor | 1136 S Delano Ct W Ste B201, Chicago, IL 60605-3734 | 2011-02-17 |
| 1699376343 | Jessica Roberson | Social Worker | 1136 S Delano Ct W Ste B201, Chicago, IL 60605-3734 | 2020-11-07 |
| 1841801743 | Joy M Grange | Counselor | 1136 S Delano Ct W Ste B201, Chicago, IL 60605-3734 | 2020-08-13 |
| 1326658758 | Life Aligned Counseling and Consulting | Social Worker | 1136 S Delano Ct W Ste B201, Chicago, IL 60605-3734 | 2020-07-31 |
| 1538777420 | Tiarra Faulkner-mckinney | Counselor | 1136 S Delano Ct W Ste B201, Chicago, IL 60605-3734 | 2020-07-16 |
| 1144843038 | Your Healing Space Therapy LLC | Counselor | 1136 S Delano Ct W Ste B201, Chicago, IL 60605-3734 | 2020-05-26 |
| 1982226544 | Phoenix Rising Counseling and Guidance, LLC | Counselor | 1136 S Delano Ct W Ste B201, Chicago, IL 60605-3734 | 2020-05-17 |
| 1164054003 | Angela Nguyen | Marriage & Family Therapist | 1136 S Delano Ct W Ste B201, Chicago, IL 60605-3734 | 2020-02-09 |
| 1861024788 | Carrie Jeanine Wallace-onifade | Social Worker | 1136 S Delano Ct W Ste B201, Chicago, IL 60605-3734 | 2020-02-08 |
| 1548891351 | Holistically Divine Counseling | Counselor | 1136 S Delano Ct W Ste B201, Chicago, IL 60605-3734 | 2020-01-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568074219 | Kheri Dunkins | Counselor | 1136 S Delano Ct, Suite B201, Chicago, IL 60605 | 2020-08-22 |
| 1134739196 | Erin Odonnell | Physical Therapist | 1255 Soputh State Street, Unit 6, Chicago, IL 60605 | 2020-08-05 |
| 1225658032 | Rita Haber | Speech-Language Pathologist | 1255 S Michigan Avenue, 207, Chicago, IL 60605 | 2020-04-21 |
| 1285288753 | My Travel Guy, Inc. | Transportation Broker | 1300 S. Wabash Ave. Suite # 205, Chicago, IL 60605 | 2019-08-01 |
| 1699230417 | Iesha Marsh | Home Health Aide | 820 S Park Terrance, Apt813, Chicago, IL 60605 | 2019-02-06 |
| 1538633482 | Sara Miller | Counselor | 401 S. Lasalle St. Suite 800h, Chicago, IL 60605 | 2019-01-14 |
| 1992203798 | Lorna Johnson | Nurse Practitioner | 1740 W Taylor St., 764e Uih, Mc 509, Chicago, IL 60605 | 2018-01-26 |
| 1790226207 | Undine and Associates | Social Worker | 410 S. Michigan Ave, Ste 943, Chicago, IL 60605 | 2017-03-16 |
| 1659811529 | Paul Parpart | Occupational Therapist | 1235 S Prairie, Chicago, IL 60605 | 2017-02-27 |
| 1144679879 | Osco Drug | Ambulance | 1529 S State St 6e, Chicago, IL 60605 | 2016-06-03 |
| Find all providers in zip 60605 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366058075 | Allyssa Rose Bertram | Counselor | 4055 W Peterson Ave Ste 202, Chicago, IL 60646-6183 | 2020-09-17 |
| 1952914707 | Tara Ufer | Counselor | 400 W Deming Pl Apt 9g, Chicago, IL 60614-1702 | 2020-08-30 |
| 1104439694 | Alisa Williams | Counselor | 409 E 62nd St, Chicago, IL 60637-6097 | 2020-08-25 |
| 1730791492 | Forward Intentions Therapy LLC | Counselor | 1309 N Ashland Ave, Chicago, IL 60622-8744 | 2020-08-23 |
| 1184232183 | Isaac William Samuelson | Counselor | 3058 W Cortland St Apt 2, Chicago, IL 60647-5075 | 2020-07-16 |
| 1346861242 | Hannah Conner | Counselor | 2756 N Pine Grove Ave Apt 705, Chicago, IL 60614-6167 | 2020-05-01 |
| 1881215804 | Pamela Ann Brazelton-sykes | Counselor | Pioneer Gardens Supportive Living, 3800 S King Dr, Chicago, IL 60653 | 2020-04-30 |
| 1619597259 | Charles Chevell Hurt | Counselor | 1606 W Wallen Ave Apt 1, Chicago, IL 60626-6592 | 2020-04-23 |
| 1851911580 | Jessica C Baran | Counselor | 5200 S Blackstone Ave Apt 401, Chicago, IL 60615-6011 | 2020-04-22 |
| 1659907350 | Lauren Graner | Counselor | 2845 N Sheridan Rd # 708, Chicago, IL 60657-7227 | 2020-03-14 |
| Find all providers in CHICAGO | ||||
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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.