Healthcare Provider Details

I. General information

NPI: 1437468436
Provider Name (Legal Business Name): JESSICA E DYREK LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2010
Last Update Date: 09/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SPINNING WHEEL RD SUITE 422
HINSDALE IL
60521-2914
US

IV. Provider business mailing address

18W075 JAMESTOWN LN
VILLA PARK IL
60181-3864
US

V. Phone/Fax

Practice location:
  • Phone: 630-272-4966
  • Fax:
Mailing address:
  • Phone: 630-272-4966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.007616
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: