Provider Demographics
NPI:1639538853
Name:HOOKER, JEREMY (MSED, LCPC)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:HOOKER
Suffix:
Gender:M
Credentials:MSED, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:NACHUSA
Mailing Address - State:IL
Mailing Address - Zip Code:61057-0100
Mailing Address - Country:US
Mailing Address - Phone:815-284-7796
Mailing Address - Fax:
Practice Address - Street 1:1261 IL-38
Practice Address - Street 2:
Practice Address - City:NACHUSA
Practice Address - State:IL
Practice Address - Zip Code:61057
Practice Address - Country:US
Practice Address - Phone:815-284-7796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.005647101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional