Healthcare Provider Details

I. General information

NPI: 1619808540
Provider Name (Legal Business Name): JORDAN FREES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PENNSYLVANIA AVE STE 201
GLEN ELLYN IL
60137-8303
US

IV. Provider business mailing address

550 PENNSYLVANIA AVE STE 201
GLEN ELLYN IL
60137-8303
US

V. Phone/Fax

Practice location:
  • Phone: 630-410-9578
  • Fax: 630-296-0749
Mailing address:
  • Phone: 630-410-9578
  • Fax: 630-296-0749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number150.129105
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: