Provider Demographics
NPI:1104943315
Name:CADIEUX, JAMIE MICHELLE
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:MICHELLE
Last Name:CADIEUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:MICHELLE
Other - Last Name:PITZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1710 N. RANDALL ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123
Mailing Address - Country:US
Mailing Address - Phone:847-695-6191
Mailing Address - Fax:847-697-2438
Practice Address - Street 1:1710 N. RANDALL ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123
Practice Address - Country:US
Practice Address - Phone:847-695-6191
Practice Address - Fax:847-697-2438
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178003577101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional