National Provider Identifier Database

KELLYN JACKSON, LPC, R-DMT – NPI #1073138194
Professional


Contact Information

KELLYN JACKSON, LPC, R-DMT
2835 N SHEFFIELD AVE STE 304
CHICAGO, IL60657-5084
Phone: 630-866-5666
Fax:
Website:
Specialty Taxonomy Code
* Professional 101YP2500X
Dance Therapist 225600000X

* Indicates primary specialty

NPI Profile & details for KELLYN JACKSON

NPI Number 1073138194
Credentials LPC, R-DMT
Entity Individual
Enumeration date 06/15/2020
Last updated 10/04/2022 - About 4 years ago
Sole proprietor1 Yes
Identifiers
  • IL License #: 178016509
  • IL License #: R-DMT-2538
  • IL Other: 1619493855 PRIVATE INSURANCE
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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