Provider Demographics
NPI:1205728789
Name:CARSON JACKSON, CATRIESE (LCSW)
Entity type:Individual
Prefix:
First Name:CATRIESE
Middle Name:
Last Name:CARSON JACKSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 W RIVER ST
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3242
Mailing Address - Country:US
Mailing Address - Phone:815-549-8575
Mailing Address - Fax:
Practice Address - Street 1:577 E MARTIN AVE
Practice Address - Street 2:
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970-2000
Practice Address - Country:US
Practice Address - Phone:815-549-8575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty