Provider Demographics
NPI:1376149997
Name:FELDMAN, JACLYN MADISON
Entity Type:Individual
Prefix:MS
First Name:JACLYN
Middle Name:MADISON
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 W WRIGHTWOOD AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2317
Mailing Address - Country:US
Mailing Address - Phone:847-863-7752
Mailing Address - Fax:
Practice Address - Street 1:155 N MICHIGAN AVE STE 380
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7710
Practice Address - Country:US
Practice Address - Phone:847-863-7752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical