Healthcare Provider Details

I. General information

NPI: 1821438102
Provider Name (Legal Business Name): JESSICA ELIZABETH PLONKA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W BUENA AVE
CHICAGO IL
60613-1612
US

IV. Provider business mailing address

621 S PLYMOUTH CT #603
CHICAGO IL
60605-1841
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-8052
  • Fax:
Mailing address:
  • Phone: 651-485-8229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: