Active NPI
Jessica Jackson
- Professional Counselor
- Bourbonnais, IL
National Provider Identifier
1932974102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 178.019460
- Practice address
- 1532 Northfield Meadows Blvd Apt 4
Bourbonnais, IL 60914-4833 - Phone
- (773) 313-5556
- NPI assigned
- Nov 17, 2023
- 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 | 178.019460 | IL | Primary |
Addresses
Primary practice location
1532 Northfield Meadows Blvd Apt 4
Bourbonnais, IL 60914-4833
Mailing address
1532 Northfield Meadows Blvd Apt 4
Bourbonnais, IL 60914-4833
Phone (773) 313-5556
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.019460 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1700179200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1700179200000",
"number": "1932974102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1532 NORTHFIELD MEADOWS BLVD APT 4",
"city": "BOURBONNAIS",
"state": "IL",
"postal_code": "609144833",
"telephone_number": "773-313-5556"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1532 NORTHFIELD MEADOWS BLVD APT 4",
"city": "BOURBONNAIS",
"state": "IL",
"postal_code": "609144833",
"telephone_number": "773-313-5556"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JESSICA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-11-17",
"last_updated": "2023-11-17",
"certification_date": "2023-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178.019460",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bourbonnais, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2023; 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.