Provider Demographics
NPI:1609352087
Name:MASCENIC, JESSICA (LCPC, ATR-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MASCENIC
Suffix:
Gender:F
Credentials:LCPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 N CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-1511
Mailing Address - Country:US
Mailing Address - Phone:630-244-1780
Mailing Address - Fax:
Practice Address - Street 1:432 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191-1511
Practice Address - Country:US
Practice Address - Phone:630-244-1780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2023-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180014211101YP2500X
IL178011757101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1962696054Other205702528