Provider Demographics
NPI:1962003699
Name:IMPASTATO, JAMIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:IMPASTATO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 GOLF RD STE 1200
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-4229
Mailing Address - Country:US
Mailing Address - Phone:847-220-7629
Mailing Address - Fax:
Practice Address - Street 1:1600 GOLF RD STE 1200
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-4229
Practice Address - Country:US
Practice Address - Phone:184-722-0762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150012290104100000X
IL149.0246051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker