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Deactivated NPI 1245681840 Deactivated / Inactive NPI Female Practitioner

Iva Jackson , LPC

Counselor - Professional • Chicago, IL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Iva Jackson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date June 24, 2016
NPI Deactivation Date November 22, 2023
Total Practice Duration ~7 Years of Practice (2016 – 2023)

Professional Overview & Biography Verified Profile Summary

Iva Jackson, LPC was a registered Counselor - Professional practicing in Chicago, IL. Throughout an active medical career spanning 7 years, Iva Jackson provided care at the practice location at 2310 W ROOSEVELT RD until profile deactivation on 2023-11-22.

Practice Location & Contact Primary Location

Practice Address

2310 W Roosevelt Rd

Chicago, IL 606081131

Telephone 3126557245
Fax 7733498080
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Counselor - Professional in Chicago, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 13.4 Yrs
State Avg: 17.0 Yrs
Regional Practice Density
2437 Specialists

Practicing in Chicago, IL (9683 Statewide)

Telehealth Adoption Rate
1.7% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Counselor - Professional Primary Specialty

NUCC Taxonomy Code: 101YP2500X

State License IL 72455

Definition to come...

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
Kandi Fowler , CADC, MISA1, CAMS11

Counselor - Addiction (Substance Use Disorder)

NPI 1174079313

Certified Alcohol and Drug Counselor, MISA1, CAMS11

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated November 22, 2023

Record deactivated on November 22, 2023

NPI Profile Active June 24, 2016

NPI status registered as active in NPPES database

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Updated Practice Location June 24, 2016

Registered at 2310 W ROOSEVELT RD, CHICAGO, IL 606081131 (Tel: 3126557245)

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Updated Business Mailing Address June 24, 2016

Registered at 2310 W ROOSEVELT RD, CHICAGO, IL 606081131 (Tel: 3126557245)

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Provider Name / Credentials Updated June 24, 2016

Recorded as IVA JACKSON, LPC

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Medical Taxonomy / Specialty Registered (Primary Specialty) June 24, 2016

Counselor (License #72455 in IL)

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Initial NPI Registration & Enumeration June 24, 2016

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1245681840
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 24, 2016
Last Update: June 24, 2016
Deactivation Date: November 22, 2023

Mailing Address

2310 W Roosevelt Rd

Chicago, IL 606081131

Phone: 3126557245

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.