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General NPI Number Information
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NPI Number | 1750703583
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Entity Type | Individual
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Provider Name | JISELLE ROMAN LCPC
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Gender | Female
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Dates
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Enumeration Date | 01/14/2014
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Last Update Date | 03/31/2023
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Provider Practice Location Address
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Address Line | 10720 PRINCESS AVE
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City | CHICAGO RIDGE
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State | IL
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Zip | 60415-2139
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Country | US
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Telephone | 773-627-7914
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Fax | 708-575-6527
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Provider Business Mailing Address
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Address Line | 9631 S CICERO AVE # 1459
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City | OAK LAWN
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State | IL
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Zip | 60453-3137
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Country | US
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Telephone | 773-627-7914
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Fax | 708-575-6527
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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 | 178.007483
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 2388551
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.009936
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License Number State | IL
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