Individual
DR. JACKSON NEWSOME
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
1331 N BOSWORTH AVE APT 3, CHICAGO, IL 60642-3421
(773) 683-3200
Mailing address
1331 N BOSWORTH AVE APT 3, CHICAGO, IL 60642-3421
(773) 683-3200
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071010649
IL
Other
Enumeration date
10/28/2021
Last updated
10/12/2023
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