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Organization
TRANSFORMATIVE WELLNESS, INC
Active
Organization
TRANSFORMATIVE WELLNESS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAUDETTE M JACKSON PHD (PRESIDENT/CLINICAL PSYCHOLOGIST)
(312) 375-5621
Entity
Organization
Contact information
Practice address
611 W BRIAR PL STE 6, CHICAGO, IL 60657-4560
(312) 375-5621
Mailing address
7725 S CRANDON AVE, CHICAGO, IL 60649-4118
(312) 375-5621
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
04/29/2022
Last updated
05/25/2022
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