Provider Demographics
NPI:1407259856
Name:ROVNER, JACLYN (CRC, LCPC)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:ROVNER
Suffix:
Gender:F
Credentials:CRC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 SLAWIN COURT
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056
Mailing Address - Country:US
Mailing Address - Phone:847-789-7155
Mailing Address - Fax:
Practice Address - Street 1:5101 WASHINGTON ST STE 1102
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2988
Practice Address - Country:US
Practice Address - Phone:847-975-1009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2024-11-14
Deactivation Date:2015-09-15
Deactivation Code:
Reactivation Date:2017-08-18
Provider Licenses
StateLicense IDTaxonomies
103K00000X
IL180.016538101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst