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MARTINA SHAUNTAE JACKSON
NPI 1871114215
Counselor - Professional in Chicago, IL

Active since April 27, 2020
2008 N LAWLER AVE, CHICAGO, IL 60639(708) 860-1201(708) 221-6679 Get Directions Write a Review

NPPES record last updated: April 27, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Martina Shauntae Jackson NPPES

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

MARTINA SHAUNTAE JACKSON (NPI 1871114215) is an individual professional provider in Chicago, Illinois, licensed in Illinois (178.014194) and active in the NPI registry since April 2020.

NPPES Registry Identity

NPI1871114215
Entity TypeIndividualFemale
Primary Taxonomy101YP2500X
Provider Legal NameMARTINA SHAUNTAE JACKSON
Location Address2008 N LAWLER AVEChicago, IL 60639-3136
Mailing Address2008 N Lawler AveChicago, IL 60639-3136 · (708) 860-1201 · Fax (708) 221-6679
Phone(708) 860-1201
Fax(708) 221-6679
Sole ProprietorNo
Enumeration DateApril 27, 2020
NPPES CertifiedApril 27, 2020
✔ NPI 1871114215 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in IL · 178.014194
2008 N LAWLER AVE, Chicago, IL 60639
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Other Identifiers 1

Other178.014194IL · Licensed Professional Counselor

Other Providers at the Same Location NPPES 2

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

ADRIANA J BUTCHER
Counselor (Professional)
2008 N LAWLER AVE
CHICAGO, IL 60639
Cook County (708) 860-1201
RL GROUP
Clinic/Center (Rehabilitation, Substance Use Disorder)
2008 N LAWLER AVE
CHICAGO, IL 60639
Cook County (708) 860-1201

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 Martina Jackson's NPI number?

The NPI number for Martina Jackson is 1871114215. It was assigned to this individual provider in the NPPES registry on April 27, 2020.

Where is Martina Jackson located?

Martina Jackson practices at 2008 N Lawler Ave, Chicago, IL 60639. The listed phone number is (708) 860-1201.

What is Martina 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 Martina Jackson was last updated on April 27, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.