Provider Demographics
NPI:1902557127
Name:MORTON, JACKIE RASHELLE (CADC)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:RASHELLE
Last Name:MORTON
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:POOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1227 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2524
Mailing Address - Country:US
Mailing Address - Phone:217-679-1406
Mailing Address - Fax:217-679-1545
Practice Address - Street 1:1227 S 9TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-2524
Practice Address - Country:US
Practice Address - Phone:217-679-1406
Practice Address - Fax:217-679-1545
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL35500101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)