Provider Demographics
NPI:1235471806
Name:WESOLOWSKI, JACLYN (MA, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:
Last Name:WESOLOWSKI
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25224 W EAMES ST
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-5215
Mailing Address - Country:US
Mailing Address - Phone:815-922-9561
Mailing Address - Fax:
Practice Address - Street 1:25224 W EAMES ST
Practice Address - Street 2:
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-5215
Practice Address - Country:US
Practice Address - Phone:815-467-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008582101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional