Provider Demographics
NPI:1831911122
Name:SANTY, JACKSON CORBIN (MSW)
Entity type:Individual
Prefix:MR
First Name:JACKSON
Middle Name:CORBIN
Last Name:SANTY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5140 GOLF RD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1206
Mailing Address - Country:US
Mailing Address - Phone:847-676-0078
Mailing Address - Fax:
Practice Address - Street 1:5140 GOLF RD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1206
Practice Address - Country:US
Practice Address - Phone:847-676-0078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty