Individual
MS. IDA B JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC,
Contact information
Practice address
4314 S COTTAGE GROVE AVE, SUITE 208, CHICAGO, IL 60653-3514
(312) 747-0036
(312) 747-2208
Mailing address
4314 S COTTAGE GROVE AVE, SUITE 208, CHICAGO, IL 60653-3514
(312) 747-0036
(312) 747-2208
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
180-000225
IL
Other
Enumeration date
06/30/2010
Last updated
06/30/2010
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