Healthcare Provider Details

I. General information

NPI: 1831867332
Provider Name (Legal Business Name): JORDYN RENEE POPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 W BELMONT AVE
CHICAGO IL
60657-4408
US

IV. Provider business mailing address

3420 N LAKE SHORE DR APT 8K
CHICAGO IL
60657-9416
US

V. Phone/Fax

Practice location:
  • Phone: 773-496-4433
  • Fax: 773-496-4430
Mailing address:
  • Phone: 405-795-2606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178021978
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: