Provider Demographics
NPI:1073145173
Name:FITZPATRICK, JILLIAN (PSYD)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40W120 JACK LONDON ST
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-6540
Mailing Address - Country:US
Mailing Address - Phone:630-283-2880
Mailing Address - Fax:
Practice Address - Street 1:1650 E MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2373
Practice Address - Country:US
Practice Address - Phone:630-283-2880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071010224103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical