Healthcare Provider Details

I. General information

NPI: 1144924275
Provider Name (Legal Business Name): JESSICA VANESSA RODRIGUEZ LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 MARKET ST
BLUE ISLAND IL
60406-3114
US

IV. Provider business mailing address

2022 MARKET ST
BLUE ISLAND IL
60406-3114
US

V. Phone/Fax

Practice location:
  • Phone: 619-304-8971
  • Fax:
Mailing address:
  • Phone: 619-304-8971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC18518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: