Individual provider · Type 1 NPI
Martina Shauntae Jackson
Professional Counselor · Chicago, IL
NPI number
1871114215
Active
Practice location
2008 N Lawler Ave
Chicago, IL 60639-3136
Fax (708) 221-6679
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Professional Counselor Primary | 101YP2500X | 178.014194 (IL) |
Professional Counselor: Definition to come...
2 other providers at this address
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About NPI 1871114215
Martina Shauntae Jackson's National Provider Identifier is 1871114215, issued on Apr 27, 2020. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Chicago, IL. The record was last updated on Oct 23, 2026.