Healthcare Provider Details

I. General information

NPI: 1053154260
Provider Name (Legal Business Name): ANTONIA JURKOVIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2024
Last Update Date: 06/15/2024
Certification Date: 06/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4899 N HERMITAGE AVE APT 3
CHICAGO IL
60640-4129
US

IV. Provider business mailing address

4899 N HERMITAGE AVE APT 3
CHICAGO IL
60640-4129
US

V. Phone/Fax

Practice location:
  • Phone: 773-895-4071
  • Fax:
Mailing address:
  • Phone: 773-895-4071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTONIA JURKOVIC
Title or Position: OWNER
Credential:
Phone: 773-895-4071