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General NPI Number Information
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NPI Number | 1104581255
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Entity Type | Individual
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Provider Name | JACLYN BOBINSKI LCPC
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Gender | Female
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Dates
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Enumeration Date | 11/03/2021
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Last Update Date | 11/03/2021
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Provider Practice Location Address
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Address Line | 4840 W BYRON ST
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City | CHICAGO
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State | IL
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Zip | 60641-2778
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Country | US
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Telephone | 773-573-2834
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Fax |
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Provider Business Mailing Address
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Address Line | 214 TANGLEWOOD DR
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60007-1714
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Country | US
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Telephone | 484-477-5203
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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 | 180013934
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License Number State | IL
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