Provider Demographics
NPI:1609965573
Name:FLEAGLE, JILL KATHLEEN (MPC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:KATHLEEN
Last Name:FLEAGLE
Suffix:
Gender:F
Credentials:MPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 ROCK RUN DRIVE SUITE 30
Mailing Address - Street 2:CROSSROADS A COUNSELING AND CARE CENTER
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3153
Mailing Address - Country:US
Mailing Address - Phone:815-741-3009
Mailing Address - Fax:815-741-8322
Practice Address - Street 1:1520 ROCK RUN DRIVE
Practice Address - Street 2:SUITE 30 A
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60435-3153
Practice Address - Country:US
Practice Address - Phone:815-741-3009
Practice Address - Fax:815-741-8322
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional