Provider Demographics
NPI:1225319205
Name:RAWL, JILLIAN (MA, LCPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:
Last Name:RAWL
Suffix:
Gender:F
Credentials:MA, LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10524 S KILBOURN AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-5340
Mailing Address - Country:US
Mailing Address - Phone:708-955-8331
Mailing Address - Fax:708-433-5013
Practice Address - Street 1:1121 WARREN AVE
Practice Address - Street 2:SUITE 260B
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3570
Practice Address - Country:US
Practice Address - Phone:630-903-0521
Practice Address - Fax:708-433-5013
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007268101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional