Healthcare Provider Details

I. General information

NPI: 1083015036
Provider Name (Legal Business Name): CHICAGO HUMAN POTENTIAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7231 1/2 N SHERIDAN RD
CHICAGO IL
60626-2612
US

IV. Provider business mailing address

7231 1/2 N SHERIDAN RD
CHICAGO IL
60626-2612
US

V. Phone/Fax

Practice location:
  • Phone: 773-517-3448
  • Fax: 773-262-9929
Mailing address:
  • Phone: 773-517-3448
  • Fax: 773-262-9929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149-009174
License Number StateIL

VIII. Authorized Official

Name: MS. JOSLYN K JELINEK
Title or Position: OWNER
Credential: LCSW
Phone: 773-517-3448