Provider Demographics
NPI:1467572040
Name:JASKULA, DIANE M (LCPC,CADC)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:M
Last Name:JASKULA
Suffix:
Gender:F
Credentials:LCPC,CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 TOLLGATE RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-9357
Mailing Address - Country:US
Mailing Address - Phone:847-426-0492
Mailing Address - Fax:847-426-0492
Practice Address - Street 1:551 TOLLGATE RD
Practice Address - Street 2:SUITE F
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-9357
Practice Address - Country:US
Practice Address - Phone:847-426-0492
Practice Address - Fax:847-426-0492
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional