Provider Demographics
NPI:1568763225
Name:OWCA, JAKUB R (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAKUB
Middle Name:R
Last Name:OWCA
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 1:3712 N BROADWAY ST STE 145
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4235
Mailing Address - Country:US
Mailing Address - Phone:312-771-3475
Mailing Address - Fax:773-347-1773
Practice Address - Street 1:53 W JACKSON BLVD
Practice Address - Street 2:SUITE 622
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3606
Practice Address - Country:US
Practice Address - Phone:847-902-7091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007664101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional