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General NPI Number Information
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NPI Number | 1003218199
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Entity Type | Individual
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Provider Name | JACQUELINE PEARSON SMITH
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Gender | Female
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Dates
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Enumeration Date | 09/19/2014
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Last Update Date | 09/19/2014
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Provider Practice Location Address
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Address Line | 18640 W. BELVIDERE ROAD
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City | GRAYSLAKE
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State | IL
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Zip | 60030
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Country | US
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Telephone | 847-548-6000
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Fax | 847-587-3100
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Provider Business Mailing Address
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Address Line | 2640 NISH RD
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City | CRYSTAL LAKE
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State | IL
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Zip | 60012-1509
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Country | US
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Telephone | 815-557-6563
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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