Provider Demographics
NPI:1558853895
Name:KNOCHEL, JESSICA MARIE (LCPC, BC-DMT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:KNOCHEL
Suffix:
Gender:F
Credentials:LCPC, BC-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 W CHARLESTON ST APT 403
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4537
Mailing Address - Country:US
Mailing Address - Phone:847-209-4566
Mailing Address - Fax:
Practice Address - Street 1:2035 W CHARLESTON ST APT 403
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4537
Practice Address - Country:US
Practice Address - Phone:847-209-4566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-02
Last Update Date:2018-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011231101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional