Melody Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.015461 Issued in IL

Practice address

1263 Prince Dr
South Holland, IL 60473-1128

Phone

(773) 507-2660

NPI assigned

Feb 14, 2013

Last updated

Feb 14, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Unify Counseling Inc

  • Clinic/Center
  • Northfield, IL
  • NPI 1942899646

  Clinical

  Medicare reassignment NPD
• DPT Holdings, LLC

  dba Doctors of Physical Therapy

  • Physical Therapist
  • Plainfield, IL
  • NPI 1689648602
  NPD (past)

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

{
    "created_epoch": "1360800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360800000000",
    "number": "1619216413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1263 PRINCE DR",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604731128",
            "telephone_number": "773-507-2660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1263 PRINCE DR",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604731128",
            "telephone_number": "773-507-2660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MELODY",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-02-14",
        "last_updated": "2013-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.015461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Infusion Plus Inc.
• Isd Renal Inc (South Holland Renal Center)
• Aminat Abisola Ishadimu
• Joy Iskandar, D.O.
• J52 Transportation LLC
• Lina Jamal Abdallah Ghazal, MD
• Jasper Gulotta (South Holland Optometric Associates)
• Bertha Jasso-Nunez
• Nadia Jenkins, LCPC
• Jerry Lee Jensen, DO

• Clinical Social Worker in South Holland, IL
• Providers in South Holland, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.