Healthcare Provider Details

I. General information

NPI: 1275203242
Provider Name (Legal Business Name): RACHEL H JACOBS PHD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 W DIVERSEY PKWY STE 209
CHICAGO IL
60614-1682
US

IV. Provider business mailing address

561 W DIVERSEY PKWY STE 209
CHICAGO IL
60614-1682
US

V. Phone/Fax

Practice location:
  • Phone: 773-830-4725
  • Fax:
Mailing address:
  • Phone: 773-830-4725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: RACHEL H JACOBS
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 773-830-4725