Provider Demographics
NPI:1639698772
Name:RITZ, JACQUELINE (LPC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:RITZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:ZARTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 W CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-5106
Mailing Address - Country:US
Mailing Address - Phone:312-943-6545
Mailing Address - Fax:708-362-6217
Practice Address - Street 1:310 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-5106
Practice Address - Country:US
Practice Address - Phone:312-943-6545
Practice Address - Fax:708-362-6217
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-10
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178012485101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
IL180012578101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health