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Deactivated NPI 1043312960 Deactivated / Inactive NPI Female Practitioner

Willie Mae Jackson

Dietetic Technician, Registered • 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, Willie Jackson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date September 01, 2006
NPI Deactivation Date August 19, 2021
Total Practice Duration ~15 Years of Practice (2006 – 2021)

Professional Overview & Biography Verified Profile Summary

Willie Jackson was a registered Dietetic Technician, Registered practicing in Chicago, IL. Throughout an active medical career spanning 15 years, Willie Jackson provided care at the practice location at 820 S DAMEN AVE until profile deactivation on 2021-08-19.

Practice Location & Contact Primary Location

Practice Address

820 S Damen Ave

Chicago, IL 606123728

Telephone 3125693565
Fax 3125696118
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Dietetic Technician, Registered in Chicago, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 10.2 Yrs
Regional Practice Density
6 Specialists

Practicing in Chicago, IL (8 Statewide)

Telehealth Adoption Rate
0.0% 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

Dietetic Technician, Registered Primary Specialty

NUCC Taxonomy Code: 136A00000X

A Dietetic Technician, Registered (DTR)/Nutrition and Dietetics Technician, Registered (NDTR) is an individual holding a nationally protected title issued by the Commission on Dietetic Registration (CDR) to qualified individuals who obtain an associate's degree or higher and successfully complete a sliding set of academic, examination, and practice requirements accredited by the Accreditation Council for Education in Nutrition and Dietetics (ACEND) or established by CDR, the nature of which are dependent upon the level of academic degree obtained. The scope of practice of the NDTR focuses on food, nutrition, and dietetics practice, as well as related services. NDTRs work under the supervision of a Registered Dietitian Nutritionist (RDN) when in direct patient/client nutrition care, and may work independently in providing general nutrition education to healthy populations. Patient/client populations include individuals receiving individualized care who have medical conditions or diseases, as well as at-risk individuals receiving personalized nutrition guidance as part of preventive health care.

Practice Associates & Co-Workers

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

8 Associated Practitioners
Dolores Boy

Dietitian, Registered

NPI 1003916271
Doris Marshall

Dietetic Technician, Registered

NPI 1174530331
Laura Dolezal , RD, LDN

Dietitian, Registered

NPI 1184833170

Registered Dietitian, Licensed Dietitian Nutritionist

Margaret Myslinsky , RNMSRD

Dietitian, Registered

NPI 1336154913
Corazon Mindo

Nutritionist

NPI 1639187842
Annette Keys

Dietitian, Registered

NPI 1710995196

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 August 19, 2021

Record deactivated on August 19, 2021

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 820 S DAMEN AVE, CHICAGO, IL 606123728 (Tel: 3125693565)

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Updated Business Mailing Address July 08, 2007

Registered at 820 S DAMEN AVE, CHICAGO, IL 606123728 (Tel: 3125693565)

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Provider Name / Credentials Updated July 08, 2007

Recorded as WILLIE JACKSON

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dietetic Technician, Registered

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Initial NPI Registration & Enumeration September 01, 2006

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: 1043312960
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 01, 2006
Last Update: July 08, 2007
Deactivation Date: August 19, 2021

Mailing Address

820 S Damen Ave

Chicago, IL 606123728

Phone: 3125693565

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.