Healthcare Provider Details

I. General information

NPI: 1437515368
Provider Name (Legal Business Name): JESSICA HANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 GREENWOOD ST
EVANSTON IL
60201-6508
US

IV. Provider business mailing address

900 GREENWOOD ST
EVANSTON IL
60201-6508
US

V. Phone/Fax

Practice location:
  • Phone: 224-714-7568
  • Fax:
Mailing address:
  • Phone: 224-714-7568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166001861
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: