Provider Demographics
NPI:1386366268
Name:MCCLEARY, JACOB
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:MCCLEARY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-2481
Mailing Address - Country:US
Mailing Address - Phone:224-656-4617
Mailing Address - Fax:
Practice Address - Street 1:1850 OAK ST
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3042
Practice Address - Country:US
Practice Address - Phone:224-505-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator