Provider Demographics
NPI:1154357044
Name:JAFFE, KAREN LESLIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LESLIE
Last Name:JAFFE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 NORTH MICHIGAN AVENUE
Mailing Address - Street 2:SUITE 607
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-6060
Mailing Address - Country:US
Mailing Address - Phone:312-263-1780
Mailing Address - Fax:
Practice Address - Street 1:30 NORTH MICHIGAN AVENUE
Practice Address - Street 2:SUITE 607
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-6060
Practice Address - Country:US
Practice Address - Phone:312-263-1780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71-2699103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL679580-62Medicare ID - Type Unspecified