Provider Demographics
NPI:1093006207
Name:MCCORMACK, JESSICA LEE (MS LMFT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:MCCORMACK
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-1736
Mailing Address - Country:US
Mailing Address - Phone:773-571-9476
Mailing Address - Fax:
Practice Address - Street 1:1333 BURR RIDGE PKWY
Practice Address - Street 2:200
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527
Practice Address - Country:US
Practice Address - Phone:708-429-0353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000978106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist