Healthcare Provider Details

I. General information

NPI: 1720997745
Provider Name (Legal Business Name): JESSICA MARIE TILLMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 CRAWFORD AVE STE 22
EVANSTON IL
60201-4983
US

IV. Provider business mailing address

5050 N BROADWAY ST APT 527
CHICAGO IL
60640-6373
US

V. Phone/Fax

Practice location:
  • Phone: 847-512-7225
  • Fax:
Mailing address:
  • Phone: 210-461-2564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178033273
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: