Provider Demographics
NPI:1497375844
Name:CONEY, JASCLYN N (MA, MDIV)
Entity Type:Individual
Prefix:
First Name:JASCLYN
Middle Name:N
Last Name:CONEY
Suffix:
Gender:F
Credentials:MA, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14520 DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-2442
Mailing Address - Country:US
Mailing Address - Phone:609-356-9951
Mailing Address - Fax:
Practice Address - Street 1:935 175TH ST STE 300
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2073
Practice Address - Country:US
Practice Address - Phone:708-885-9288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty