Provider Demographics
NPI:1154488179
Name:PETCHENIK, JODI (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:JODI
Middle Name:
Last Name:PETCHENIK
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2726 HAWTHORN LN
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2140
Mailing Address - Country:US
Mailing Address - Phone:847-650-4444
Mailing Address - Fax:
Practice Address - Street 1:2726 HAWTHORN LN
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2140
Practice Address - Country:US
Practice Address - Phone:847-650-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490104941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical