Mary Jackson

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-21-57035 Issued in IL

Practice address

4559 Benes Ave
Glen Carbon, IL 62034-1541

Phone

(217) 525-8332

NPI assigned

Aug 13, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Acorn Health of Illinois, LLC

  • Behavior Analyst
  • O Fallon, IL
  • NPI 1144867854
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688342400000",
    "number": "1275144149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4559 BENES AVE",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620341541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4559 BENES AVE",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620341541",
            "telephone_number": "217-525-8332"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6 Eagle Ctr Ste 1",
            "address_purpose": "LOCATION",
            "city": "O Fallon",
            "state": "IL",
            "postal_code": "622691945",
            "country_code": "US",
            "telephone_number": "618-206-8816",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 Saint Louis St Ste 1",
            "address_purpose": "LOCATION",
            "city": "Edwardsville",
            "state": "IL",
            "postal_code": "620251979",
            "country_code": "US",
            "telephone_number": "618-226-4397",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-13",
        "last_updated": "2023-07-03",
        "certification_date": "2023-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "IL",
            "license": "1-21-57035",
            "primary": true
        },
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Infinite Vitality LTD
• Infinite Wellness Chiropractic, LTD.
• Inner Compass Counseling PLLC
• Insightful Minds Counseling
• Integrated Medical Group LTD
• Kaide Jackstadt
• Theresa Jacobs
• Kristen James, M.D.
• Jessica M Jarman
• Jeffrey S. Mastroianni D.M.D., M.S., P.C.

• Behavior Analyst in Glen Carbon, IL
• Providers in Glen Carbon, IL by specialty
• Behavior Analyst in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.