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KELLYN JACKSON LPC, R-DMT
NPI 1073138194
Counselor - Professional in Chicago, IL

Active since June 15, 2020
2835 N SHEFFIELD AVE STE 304, CHICAGO, IL 60657(630) 866-5666 Get Directions Write a Review

NPPES record last updated: October 4, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Oct 4, 2022, Aug 7, 2021, Jun 15, 2020 (3 updates tracked since 2020).

About Kellyn Jackson Lpc, R-dmt NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLYN JACKSON LPC, R-DMT (NPI 1073138194) is an individual professional provider in Chicago, Illinois, licensed in Illinois (178016509) and active in the NPI registry since June 2020. She maintains a secondary practice location in Chicago.

NPPES Registry Identity

NPI1073138194
Entity TypeIndividualFemale
Primary Taxonomy101YP2500X
Provider Legal NameKELLYN JACKSONCredential: LPC, R-DMT
Location Address2835 N SHEFFIELD AVE STE 304Chicago, IL 60657-5084
Mailing Address7400 N Sheridan Rd Apt 3aChicago, IL 60626-2059 · (847) 624-5298
Phone(630) 866-5666
Sole ProprietorYes
Enumeration DateJune 15, 2020
Last NPPES UpdateOctober 4, 20223 updates tracked since enumeration
NPPES CertifiedOctober 4, 2022
✔ NPI 1073138194 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in IL · 178016509
Also ListedDance TherapistTaxonomy 225600000X · License R-DMT-2538 (IL)
2835 N SHEFFIELD AVE STE 304, Chicago, IL 60657
Open in Google Maps ↗

Secondary Practice Location 1

Location 12310 W Roosevelt RdChicago, IL 60608-1131 · Phone (312) 439-1552

Other Identifiers 1

Other1619493855IL · Private Insurance

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NATALIE ERIN BAUR LSW
Social Worker
2835 N SHEFFIELD AVE STE 304
CHICAGO, IL 60657
Cook County (312) 291-1595
HANNAH PAVETT
Psychologist (Clinical)
2835 N SHEFFIELD AVE STE 304
CHICAGO, IL 60657
Cook County (773) 236-1647
HEALTHWISZ CONSULTING LLC
Counselor (Mental Health)
2835 N SHEFFIELD AVE STE 304
CHICAGO, IL 60657
Cook County (630) 341-0057

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kellyn Jackson's NPI number?

The NPI number for Kellyn Jackson is 1073138194. It was assigned to this individual provider in the NPPES registry on June 15, 2020.

Where is Kellyn Jackson located?

Kellyn Jackson practices at 2835 N Sheffield Ave Ste 304, Chicago, IL 60657. The listed phone number is (630) 866-5666.

What is Kellyn Jackson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

When was this NPI record last updated?

The NPPES record for Kellyn Jackson was last updated on October 4, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.