Provider Demographics
NPI:1326535204
Name:JAMIE KREITER THERAPY
Entity Type:Organization
Organization Name:JAMIE KREITER THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KREITER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-363-0628
Mailing Address - Street 1:2535 N CALIFORNIA AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2636
Mailing Address - Country:US
Mailing Address - Phone:847-363-0628
Mailing Address - Fax:
Practice Address - Street 1:3808 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-5382
Practice Address - Country:US
Practice Address - Phone:847-363-0628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149016782251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health