Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 178016475 | IL |
N | 106S00000X | Behavior Technician | 18-55537 | IL |
NPI | 1003308008 |
---|---|
Provider Name | Ann Sylvia Jakubczak |
First Address | Arlington Hts, IL 60004-7814 |
Second Address | Arlington Hts, IL 60004-7814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2018 |
Last Update Date | 29/10/2020 |