Provider Demographics
NPI:1841720083
Name:JACOBY, JILLIAN (MA LCPC)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:JACOBY
Suffix:
Gender:F
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 KELBURN RD APT 223
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4364
Mailing Address - Country:US
Mailing Address - Phone:847-668-6250
Mailing Address - Fax:
Practice Address - Street 1:411 KELBURN RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4380
Practice Address - Country:US
Practice Address - Phone:847-668-6250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
IL178013016101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional