Jackson, Kenneth

Jackson, Kenneth is an sole proprietor health care provider with primary practice located at 5701 N Ashland Ave Suite 205-A, Chicago IL 60660-4027. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Health Service. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Jackson, Kenneth can be contacted via phone (773) 454-7202.

Contact Information

Primary practice address
5701 N Ashland Ave Suite 205-A Chicago IL 60660-4027
Phone: (773) 454-7202
Fax: (773) 465-5041
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 071007090 Illinois
Behavioral Health & Social Service Providers / Health Service 103TH0100X 20042218A Indiana

Profile Details

NPI number 1588762108
LBN Legal business name Jackson, Kenneth
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 20th, 2006
Last updated Nov 4th, 2010 - about 14 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.

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