Provider Demographics
NPI:1164077509
Name:COOPER, JAMIE LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:LYNN
Last Name:COOPER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JAMIE
Other - Middle Name:LYNN
Other - Last Name:PARISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:28W671 GARYS MILL RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1564
Mailing Address - Country:US
Mailing Address - Phone:630-293-9860
Mailing Address - Fax:630-293-9861
Practice Address - Street 1:28W671 GARYS MILL RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1564
Practice Address - Country:US
Practice Address - Phone:630-293-9860
Practice Address - Fax:630-293-9861
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071010067103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical