Provider Demographics
NPI:1164164851
Name:PAC, JAIME L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:L
Last Name:PAC
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 1:14541 AUDUBON TRL
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:IL
Mailing Address - Zip Code:60442-7716
Mailing Address - Country:US
Mailing Address - Phone:708-945-0142
Mailing Address - Fax:
Practice Address - Street 1:14541 AUDUBON TRL
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:IL
Practice Address - Zip Code:60442-7716
Practice Address - Country:US
Practice Address - Phone:708-945-0142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008409103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist