Healthcare Provider Details

I. General information

NPI: 1588299705
Provider Name (Legal Business Name): DOROTHY JAKUBOWSKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BURR RIDGE PKWY STE 201
BURR RIDGE IL
60527-0864
US

IV. Provider business mailing address

PO BOX 40412
BELFAST ME
04915-1255
US

V. Phone/Fax

Practice location:
  • Phone: 866-259-1631
  • Fax: 855-618-2629
Mailing address:
  • Phone: 312-818-4650
  • Fax: 855-618-2629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.023588
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: