Individual
COLLEEN M JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1136 S DELANO CT W STE B201, CHICAGO, IL 60605-3734
(708) 845-5500
(708) 845-5505
Mailing address
15127 S 73RD AVE STE G, ORLAND PARK, IL 60462-3425
(708) 845-5500
(708) 845-5505
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
178015305
IL
Other
Enumeration date
10/15/2019
Last updated
10/15/2019
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