Provider Demographics
NPI:1093981045
Name:LOPER, JO ANNE
Entity Type:Individual
Prefix:MRS
First Name:JO ANNE
Middle Name:
Last Name:LOPER
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 1:4028 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2925
Mailing Address - Country:US
Mailing Address - Phone:773-282-5274
Mailing Address - Fax:773-282-5358
Practice Address - Street 1:4028 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2925
Practice Address - Country:US
Practice Address - Phone:773-282-5274
Practice Address - Fax:773-282-5358
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILJL70000304P101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health