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General NPI Number Information
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NPI Number | 1902174329
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Entity Type | Individual
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Provider Name | JACQUELYN LEBRECK LCPC
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Gender | Female
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 06/18/2015
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Provider Practice Location Address
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Address Line | 110 NORTHWEST HWY
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City | FOX RIVER GROVE
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State | IL
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Zip | 60021-1017
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Country | US
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Telephone | 847-370-4969
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Fax |
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Provider Business Mailing Address
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Address Line | 110 NORTHWEST HIGHWAY
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City | FOX RIVER GROVE
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State | IL
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Zip | 60021
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Country | US
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Telephone | 847-370-4969
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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 | 180-007954
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License Number State | IL
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