Provider Demographics
NPI:1376045922
Name:RIPPLE THERAPEUTIC SERVECES
Entity Type:Organization
Organization Name:RIPPLE THERAPEUTIC SERVECES
Other - Org Name:RIPPLE THERAPEUTIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:M
Authorized Official - Last Name:JACOBE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-809-6993
Mailing Address - Street 1:541 BOARDMAN CIR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-9015
Mailing Address - Country:US
Mailing Address - Phone:630-809-6993
Mailing Address - Fax:
Practice Address - Street 1:639 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6643
Practice Address - Country:US
Practice Address - Phone:630-809-6993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.018683261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)