Provider Demographics
NPI:1831494699
Name:JACKSON-GRIFFIN, KATHRYN CARLY (MA, NCC)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:CARLY
Last Name:JACKSON-GRIFFIN
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 N MICHIGAN AVE STE 608
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7511
Mailing Address - Country:US
Mailing Address - Phone:312-883-7060
Mailing Address - Fax:312-883-7175
Practice Address - Street 1:155 N MICHIGAN AVE STE 608
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7511
Practice Address - Country:US
Practice Address - Phone:312-883-7060
Practice Address - Fax:312-883-7175
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILJ25050387686101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor