Provider Demographics
NPI:1033829213
Name:KNOBLE, JESSIE JEAN (LSW)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:JEAN
Last Name:KNOBLE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 MCHENRY RD STE 217B
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1371
Mailing Address - Country:US
Mailing Address - Phone:224-676-9800
Mailing Address - Fax:844-318-6053
Practice Address - Street 1:1207 MCHENRY RD STE 217B
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1371
Practice Address - Country:US
Practice Address - Phone:224-676-9800
Practice Address - Fax:844-318-6053
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.109163104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker