Healthcare Provider Details

I. General information

NPI: 1033036306
Provider Name (Legal Business Name): JACLYN E JAIME LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 SHERMER RD STE 232
NORTHBROOK IL
60062-4539
US

IV. Provider business mailing address

7047 W MAIN ST
NILES IL
60714-2254
US

V. Phone/Fax

Practice location:
  • Phone: 773-865-4322
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.024687
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: