Healthcare Provider Details

I. General information

NPI: 1063304483
Provider Name (Legal Business Name): JACQUELYN SPOKAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 W HIGGINS RD STE 650
HOFFMAN ESTATES IL
60169-7268
US

IV. Provider business mailing address

2800 W HIGGINS RD STE 650
HOFFMAN ESTATES IL
60169-7268
US

V. Phone/Fax

Practice location:
  • Phone: 815-947-4463
  • Fax:
Mailing address:
  • Phone: 815-947-4463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.018982
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: