Provider Demographics
NPI:1316103898
Name:JAUCH, JOHN LAWRENCE (MA, LCPC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LAWRENCE
Last Name:JAUCH
Suffix:
Gender:M
Credentials:MA, LCPC
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Mailing Address - Street 1:800 ROOSEVELT RD
Mailing Address - Street 2:BUILDING E, SUITE 220
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6680
Mailing Address - Country:US
Mailing Address - Phone:773-295-7072
Mailing Address - Fax:
Practice Address - Street 1:800 ROOSEVELT RD
Practice Address - Street 2:BUILDING E, SUITE 220
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6680
Practice Address - Country:US
Practice Address - Phone:773-295-7072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL178.005617101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1760647226OtherJOLIET CENTER FOR CLINICAL RESEARCH