Healthcare Provider Details

I. General information

NPI: 1528336328
Provider Name (Legal Business Name): JESSICA FOX LEVY LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA FOX LCPC

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 MAIN STREET SUITE 104
PARK RIDGE IL
60068
US

IV. Provider business mailing address

36 MAIN STREET, SUITE 104
PARK RIDGE IL
60068
US

V. Phone/Fax

Practice location:
  • Phone: 312-545-0500
  • Fax: 888-440-2577
Mailing address:
  • Phone: 312-545-0500
  • Fax: 888-440-2577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number180.007767
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.007767
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: