person
Martina Shauntae Jackson
Professional Counselor in Chicago, Illinois
NPI 1871114215

Martina Shauntae Jackson is a Professional Counselor based in Chicago, IL and is specialized in Professional. Martina Shauntae Jackson practices in Chicago, IL. The NPI Number for Martina Shauntae Jackson is 1871114215 and holds a License No. 178.014194 (Illinois).

The current practice location address for Martina Shauntae Jackson is 2008 N Lawler Ave, Chicago, IL and can be reached out via phone at 708-860-1201 and via fax at 708-221-6679.

Location: 2008 N Lawler Ave, Chicago, IL, 60639-3136
person
Provider Profile Details
NPI Number
1871114215
Provider Name
Martina Shauntae Jackson
Credential
Provider Entity Type
Individual
Gender
Female
Address
2008 N Lawler Ave, Chicago, IL, 60639-3136
Phone Number
708-860-1201
Fax Number
708-221-6679
Provider Enumeration Date
04/27/2020
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
178.014194 01 IL LICENSED PROFESSIONAL COUNSELOR
institution
Provider Business Practice Location Address Details
Address
2008 N Lawler Ave
City
State
Zip
60639-3136
Phone Number
708-860-1201
Fax Number
708-221-6679
person
Provider Business Mailing Address Details
Address
2008 N Lawler Ave
City
State
Zip
60639-3136
Phone Number
708-860-1201
Fax Number
708-221-6679
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
License No.
178.014194 (Illinois)
Definition
Definition to come...
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