Healthcare Provider Details

I. General information

NPI: 1154485290
Provider Name (Legal Business Name): CAROL ANN JABS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL ANN SCHECTMAN

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 AUGUSTA STREET
RIVER FOREST IL
60305-1402
US

IV. Provider business mailing address

904 LAKE AVENUE
WILMETTE IL
60091-1762
US

V. Phone/Fax

Practice location:
  • Phone: 708-209-3145
  • Fax: 708-209-3176
Mailing address:
  • Phone: 847-251-2539
  • Fax: 708-209-3176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149000724
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166000409
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: