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General NPI Number Information
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NPI Number | 1831494699
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Entity Type | Individual
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Provider Name | KATHRYN CARLY JACKSON-GRIFFIN MA, NCC
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Gender | Female
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Dates
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Enumeration Date | 01/25/2011
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Last Update Date | 07/12/2022
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Provider Practice Location Address
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Address Line | 155 N MICHIGAN AVE STE 608
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City | CHICAGO
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State | IL
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Zip | 60601-7511
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Country | US
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Telephone | 312-883-7060
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Fax | 312-883-7175
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Provider Business Mailing Address
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Address Line | 155 N MICHIGAN AVE STE 608
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City | CHICAGO
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State | IL
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Zip | 60601-7511
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Country | US
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Telephone | 312-883-7060
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Fax | 312-883-7175
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | J25050387686
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License Number State | IL
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