Healthcare Provider Details

I. General information

NPI: 1326813643
Provider Name (Legal Business Name): JAMIE RICHARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 DUNDEE RD STE 101
NORTHBROOK IL
60062-2462
US

IV. Provider business mailing address

1310 N HOYNE AVE UNIT 1
CHICAGO IL
60622-3017
US

V. Phone/Fax

Practice location:
  • Phone: 847-919-9096
  • Fax:
Mailing address:
  • Phone: 224-406-6713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number1177401
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.110147
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: