Active NPI
Jill Christine Jackson, MA, LCPC
- Professional Counselor
- Springfield, IL
National Provider Identifier
1790036846
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180.007488
- Practice address
- 215 S Grand Ave W
Springfield, IL 62704-3838 - Phone
- (217) 744-3525
- Fax
- (217) 744-3535
- NPI assigned
- Sep 28, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180.007488 | IL | Primary |
Addresses
Primary practice location
215 S Grand Ave W
Springfield, IL 62704-3838
Mailing address
215 S Grand Ave W
Springfield, IL 62704-3838
Phone (217) 744-3525
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180.007488 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gene a Brodland LCSW, LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Springfield, IL
- NPI 1528466430
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432339200000",
"number": "1790036846",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "215 S GRAND AVE W",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627043838",
"telephone_number": "217-744-3525",
"fax_number": "217-744-3535"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 S GRAND AVE W",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627043838",
"telephone_number": "217-744-3525",
"fax_number": "217-744-3535"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JILL",
"middle_name": "CHRISTINE",
"name_prefix": "Ms.",
"credential": "MA, LCPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-09-28",
"last_updated": "2015-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180.007488",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.