Provider Demographics
NPI:1679555312
Name:JELINEK, JOSLYN KAYE (LCSW)
Entity Type:Individual
Prefix:
First Name:JOSLYN
Middle Name:KAYE
Last Name:JELINEK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7231 1/2 N SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-2612
Mailing Address - Country:US
Mailing Address - Phone:773-517-3448
Mailing Address - Fax:773-262-9929
Practice Address - Street 1:7231 1/2 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-2612
Practice Address - Country:US
Practice Address - Phone:773-517-3448
Practice Address - Fax:773-262-9929
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149009174104100000X
IL049158891183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214090Medicare PIN