Provider Demographics
NPI:1710581459
Name:JAEGER, MICHELLE R (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:JAEGER
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 1:5500 CARRIAGEWAY DR APT 203C
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-3963
Mailing Address - Country:US
Mailing Address - Phone:847-454-3051
Mailing Address - Fax:847-454-3052
Practice Address - Street 1:5500 CARRIAGEWAY DR APT 203C
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-3963
Practice Address - Country:US
Practice Address - Phone:847-454-3051
Practice Address - Fax:847-454-3052
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0212431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical