Healthcare Provider Details

I. General information

NPI: 1841620986
Provider Name (Legal Business Name): MS. BRIANA JAKUBIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2013
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 N MILL ST STE F
NAPERVILLE IL
60563-4872
US

IV. Provider business mailing address

2452 LAUREL LN
SYCAMORE IL
60178-2819
US

V. Phone/Fax

Practice location:
  • Phone: 630-536-8073
  • Fax:
Mailing address:
  • Phone: 630-415-9595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178010697
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: