Provider Demographics
NPI:1427302793
Name:JESSIE, PATRICIA D (LCPC)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:D
Last Name:JESSIE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 S PLYMOUTH CT
Mailing Address - Street 2:#603
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2061
Mailing Address - Country:US
Mailing Address - Phone:312-554-0630
Mailing Address - Fax:
Practice Address - Street 1:1143 S PLYMOUTH CT
Practice Address - Street 2:#603
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2061
Practice Address - Country:US
Practice Address - Phone:312-554-0630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005430101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor