Healthcare Provider Details

I. General information

NPI: 1043995178
Provider Name (Legal Business Name): JILLIAN MIZRAJI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E WASHINGTON ST STE 1021
CHICAGO IL
60602-1710
US

IV. Provider business mailing address

2901 CENTRAL ST STE 5
EVANSTON IL
60201-1288
US

V. Phone/Fax

Practice location:
  • Phone: 312-298-9846
  • Fax:
Mailing address:
  • Phone: 872-265-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: