Provider Demographics
NPI:1619231529
Name:FITZPATRICK, JANE H (MAPC, LCPC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:H
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:MAPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1669 WINDHAM WAY STE B
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-3072
Mailing Address - Country:US
Mailing Address - Phone:618-622-2579
Mailing Address - Fax:618-624-8506
Practice Address - Street 1:1669 WINDHAM WAY STE B
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-3072
Practice Address - Country:US
Practice Address - Phone:618-622-2579
Practice Address - Fax:618-624-8506
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007978101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional