Healthcare Provider Details

I. General information

NPI: 1336600212
Provider Name (Legal Business Name): JACLYNN SUZANNE CHAPMAN LCSW, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 LAKE COOK RD
NORTHBROOK IL
60062-1060
US

IV. Provider business mailing address

110 WAKEFIELD LN
GENEVA IL
60134-1761
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number33984
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.102834
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.022620
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW25005
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: