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General NPI Number Information
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NPI Number | 1225316581
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Entity Type | Individual
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Provider Name | SHANA ONIELLA JACKSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/03/2011
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 401 N MICHIGAN AVE
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City | CHICAGO
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State | IL
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Zip | 60611-4255
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Country | US
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Telephone | 312-798-9212
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Fax | 844-246-6796
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Provider Business Mailing Address
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Address Line | 3551 ROGER BROOKE DR
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-4504
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW16838
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801107893
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 94269
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149020734
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License Number State | IL
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