Provider Demographics
NPI:1003462060
Name:MESKIN, JAMIE LYNN MARIE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN MARIE
Last Name:MESKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 HEATHERWAY LN APT 2D
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-2490
Mailing Address - Country:US
Mailing Address - Phone:773-420-7488
Mailing Address - Fax:
Practice Address - Street 1:125 FAIRFIELD WAY STE 380
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-3701
Practice Address - Country:US
Practice Address - Phone:815-295-5470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.019239101YM0800X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty