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NPI Profile for KELLYN JACKSON in CHICAGO, IL.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Professional |
101YP2500X | |||
Dance Therapist |
225600000X |
| NPI # | 1073138194 |
|
| Status | Active | |
| Credentials | LPC, R-DMT | |
| Entity | Individual | |
| Enumeration date | 06/15/2020 | |
| Last updated | 10/04/2022 - About 4 years ago | |
| Sole proprietor 1 | Yes | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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KELLYN JACKSON
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KELLYN JACKSON, LPC, R-DMT