Provider Demographics
NPI:1497821243
Name:COLE, JON A (PHD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:A
Last Name:COLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 COMMERCE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-1646
Mailing Address - Country:US
Mailing Address - Phone:847-529-0558
Mailing Address - Fax:
Practice Address - Street 1:205 COMMERCE DR
Practice Address - Street 2:SUITE C
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-1646
Practice Address - Country:US
Practice Address - Phone:847-529-0558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004083103T00000X, 103TB0200X, 103TC0700X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
089910OtherMANAGED HEALTH NETWORK
026611OtherVALUEOPTIONS
6158045OtherUNITED BEHAVIORAL HEALTH
035230-000OtherMAGELLAN HEALTH SERVICES
06352OtherCIGNA BEHAVIORAL HEALTH
6158045OtherUNITED BEHAVIORAL HEALTH
06352OtherCIGNA BEHAVIORAL HEALTH