Provider Demographics
NPI:1518493139
Name:LOVE JORDAN, JESSICA ASHLEY (MHS, LCPC, NCC, CADC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ASHLEY
Last Name:LOVE JORDAN
Suffix:
Gender:F
Credentials:MHS, LCPC, NCC, CADC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:LOVE JORDAN-BANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 223
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-0223
Mailing Address - Country:US
Mailing Address - Phone:312-561-6215
Mailing Address - Fax:
Practice Address - Street 1:1136 S DELANO CT W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-3740
Practice Address - Country:US
Practice Address - Phone:708-654-1929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2023-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.014995101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional