IndividualActive
Alyce Jackson, MD
NPI 1053419119 · Physical Medicine & Rehabilitation Physician · Kankakee, IL
Provider details
- NPI number
- 1053419119
- Entity type
- Individual
- Primary specialty
- Physical Medicine & Rehabilitation PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Female
- Sole proprietor
- No
- License
- 036095105 (IL)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
375 N Wall St Ste P520
Kankakee, IL 60901-3493
Phone: (815) 932-6632
Fax: (815) 932-5760
Approximate (ZIP-level) locationGet directions
Mailing address
375 N Wall St Ste P520
Kankakee, IL 60901-3493
Registry dates
- Enumerated
- 2006-09-20
- Last updated
- 2021-03-22
- Certified
- 2021-03-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.