Provider Demographics
NPI:1164642641
Name:DEYOUNG, JODI (LCSW)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:DEYOUNG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2907 BLISS CT
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-2833
Mailing Address - Country:US
Mailing Address - Phone:630-234-0178
Mailing Address - Fax:815-609-3050
Practice Address - Street 1:2907 BLISS CT
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-2833
Practice Address - Country:US
Practice Address - Phone:630-234-0178
Practice Address - Fax:815-609-3050
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2008-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490061851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149006185Medicaid