Provider Demographics
NPI:1568132611
Name:JUSKIEWICZ, JARROD (LPC)
Entity Type:Individual
Prefix:
First Name:JARROD
Middle Name:
Last Name:JUSKIEWICZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 N HAMPDEN CT APT 1301
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1627
Mailing Address - Country:US
Mailing Address - Phone:805-946-0514
Mailing Address - Fax:
Practice Address - Street 1:136 BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:CLARENDON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60514-1245
Practice Address - Country:US
Practice Address - Phone:805-946-0514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-19
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.016858101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health