Healthcare Provider Details

I. General information

NPI: 1457011934
Provider Name (Legal Business Name): THE JOSSELYN CENTER NFP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2021
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 SKOKIE BLVD
NORTHBROOK IL
60062-4118
US

IV. Provider business mailing address

405 CENTRAL AVE
NORTHFIELD IL
60093-3006
US

V. Phone/Fax

Practice location:
  • Phone: 847-441-5600
  • Fax: 847-441-7968
Mailing address:
  • Phone: 847-441-5600
  • Fax: 847-441-7968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: FRANCES RUTSTEIN
Title or Position: SENIOR BILLING COORDINATOR
Credential:
Phone: 847-441-5600