Provider Demographics
NPI:1407047368
Name:LILIE, JAMIE K (PHD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:K
Last Name:LILIE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 NORTHFIELD PLAZA
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093
Mailing Address - Country:US
Mailing Address - Phone:847-446-3531
Mailing Address - Fax:847-446-3573
Practice Address - Street 1:2 NORTHFIELD PLAZA
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093
Practice Address - Country:US
Practice Address - Phone:847-446-3531
Practice Address - Fax:847-446-3573
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0081646446OtherBCBS
IL340910Medicare PIN