Healthcare Provider Details

I. General information

NPI: 1407259856
Provider Name (Legal Business Name): JACLYN ROVNER CRC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date: 09/15/2015
Reactivation Date: 08/18/2017

III. Provider practice location address

5101 WASHINGTON ST STE 1102
GURNEE IL
60031-2988
US

IV. Provider business mailing address

625 SLAWIN COURT
MT PROSPECT IL
60056
US

V. Phone/Fax

Practice location:
  • Phone: 847-975-1009
  • Fax:
Mailing address:
  • Phone: 847-789-7155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.016538
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: