Healthcare Provider Details

I. General information

NPI: 1679434385
Provider Name (Legal Business Name): JOYCE JISEON JUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 DUNDEE RD
NORTHBROOK IL
60062-2318
US

IV. Provider business mailing address

293 OAKWOOD RD
VERNON HILLS IL
60061-2711
US

V. Phone/Fax

Practice location:
  • Phone: 847-813-9079
  • Fax: 847-813-6118
Mailing address:
  • Phone: 816-872-9245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.020546
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: