Healthcare Provider Details

I. General information

NPI: 1174267421
Provider Name (Legal Business Name): MICHELE JONAS PSYCHOLOGICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2022
Last Update Date: 04/22/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 GOLF RD STE 400
SKOKIE IL
60076-1242
US

IV. Provider business mailing address

1218 NOYES ST
EVANSTON IL
60201-2636
US

V. Phone/Fax

Practice location:
  • Phone: 224-307-4074
  • Fax:
Mailing address:
  • Phone: 224-307-4074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHELE JONAS
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 224-307-4074