Provider Demographics
NPI:1962623157
Name:JACKSON, KAREN ANN (MASTER OF SCIENCE LI)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ANN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MASTER OF SCIENCE LI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6829 ROBERTS DRIVE
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1501
Mailing Address - Country:US
Mailing Address - Phone:630-969-7645
Mailing Address - Fax:
Practice Address - Street 1:440 EAST BRIARCLIFF
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440
Practice Address - Country:US
Practice Address - Phone:630-969-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health