Provider Demographics
NPI:1376153205
Name:BERNFELD, JACKELYN (LCPC)
Entity Type:Individual
Prefix:
First Name:JACKELYN
Middle Name:
Last Name:BERNFELD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2744 WHISPERING OAKS DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6325
Mailing Address - Country:US
Mailing Address - Phone:847-341-0301
Mailing Address - Fax:
Practice Address - Street 1:3000 DUNDEE RD STE 101
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2424
Practice Address - Country:US
Practice Address - Phone:847-400-0078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012582101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health