Healthcare Provider Details

I. General information

NPI: 1952475758
Provider Name (Legal Business Name): JESSICA D SPIETH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10735 S CICERO AVE STE. 208
OAK LAWN IL
60453-5400
US

IV. Provider business mailing address

5900 OAKWOOD DR 3B
LISLE IL
60532-3084
US

V. Phone/Fax

Practice location:
  • Phone: 708-424-0001
  • Fax:
Mailing address:
  • Phone: 630-964-6514
  • Fax: 630-964-6514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: