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General NPI Number Information
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NPI Number | 1841793361
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Entity Type | Organization
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Legal Business Name | PROSPER PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 03/11/2018
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Last Update Date | 08/24/2018
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Provider Practice Location Address
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Address Line | 806 NORTH BLVD APT 202
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City | OAK PARK
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State | IL
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Zip | 60301
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Country | US
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Telephone | 630-908-9735
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Fax |
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Provider Business Mailing Address
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Address Line | 212 ELMWOOD DR
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City | NAPERVILLE
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State | IL
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Zip | 60540-7507
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Country | US
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Telephone | 630-908-9735
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/CLINICAL PSYCHOLOGIST
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Name | DR. JACLYN MARIE PATRICIA FLECK
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Credential | PSY.D.
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Telephone | 630-908-9735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.009375
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License Number State | IL
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