Jackson, Kellyn

Jackson, Kellyn is an sole proprietor health care provider with primary practice located at 2835 N Sheffield Ave Ste 304 , Chicago IL 60657-5084. She recently has 2 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Dance Therapist, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is her primary health care specialty. Jackson, Kellyn can be contacted via phone (630) 866-5666.

Contact Information

Primary practice address
2835 N Sheffield Ave Ste 304 Chicago IL 60657-5084
Phone: (630) 866-5666
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Dance Therapist 225600000X R-DMT-2538 Illinois
Behavioral Health & Social Service Providers / Professional 101YP2500X 178016509 Illinois

Profile Details

NPI number 1073138194
LBN Legal business name Jackson, Kellyn
Credentials LPC, R-DMT
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 15th, 2020
Last updated Oct 4th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1073138194 NPPES
Illinois Other 1619493855 PRIVATE INSURANCE

Popular Providers