Willie Mae Jackson
Dietetic Technician, Registered • Chicago, IL
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.
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
820 S Damen Ave
Chicago, IL 606123728
Specialty Benchmarks & Practice Insights
Comparative analytics for Dietetic Technician, Registered in Chicago, IL
Practicing in Chicago, IL (8 Statewide)
In-Person Office Visits Only
Under CMS Medicare Fee Schedule vs Standard Submitted Charges
Medical Specialties & State Licenses
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
Dietitian, Registered
Dietetic Technician, Registered
Dietitian, Registered
Registered Dietitian, Licensed Dietitian Nutritionist
Dietitian, Registered
Nutritionist
Dietitian, Registered
Career & Practice History Timeline
Chronological log of verified NPI updates, location relocations, credentials, and registry changes
Record deactivated on August 19, 2021
NPI status registered as active in NPPES database
Registered at 820 S DAMEN AVE, CHICAGO, IL 606123728 (Tel: 3125693565)
Registered at 820 S DAMEN AVE, CHICAGO, IL 606123728 (Tel: 3125693565)
Recorded as WILLIE JACKSON
Dietetic Technician, Registered
First registered as active Individual Practitioner in NPPES Database.
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NPI Administrative Meta
Mailing Address
820 S Damen Ave
Chicago, IL 606123728
Phone: 3125693565
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