Healthcare Provider Details

I. General information

NPI: 1225218704
Provider Name (Legal Business Name): JEANNE ALBERTA DICKERSON LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 ASHBROOK PL
DOWNERS GROVE IL
60515-4250
US

IV. Provider business mailing address

5450 ASHBROOK PL
DOWNERS GROVE IL
60515-4250
US

V. Phone/Fax

Practice location:
  • Phone: 630-986-8310
  • Fax:
Mailing address:
  • Phone: 630-986-8310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: