MEDICARE: LINDA BROWN-JACKSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor		IL

General Provider Information

NPI Number	:	1528268380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA BROWN-JACKSON

Provider Business Mailing Address
First Line	:	316 W 94TH PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-1504
Country	:	US
Telephone Number	:	773-928-0814
Fax Number	:

Provider Business Practice Location Address
First Line	:	316 W 94TH PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-1504
Country	:	US
Telephone Number	:	773-928-0814
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	07/20/2007

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Directions to “ LINDA BROWN-JACKSON ” Practice Location

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