Healthcare Provider Details

I. General information

NPI: 1801254263
Provider Name (Legal Business Name): JESSICA KRAKOWSKY LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6006 159TH ST BLDG C
OAK FOREST IL
60452-2904
US

IV. Provider business mailing address

6006 159TH ST BLDG C
OAK FOREST IL
60452-2904
US

V. Phone/Fax

Practice location:
  • Phone: 708-535-7320
  • Fax: 708-535-7571
Mailing address:
  • Phone: 708-535-7320
  • Fax: 708-535-7571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.009553
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: