Provider Demographics
NPI:1790424380
Name:WOLBRINK, JESSICA M (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:WOLBRINK
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 1:6155 GRAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-1651
Mailing Address - Country:US
Mailing Address - Phone:847-535-7647
Mailing Address - Fax:224-271-6642
Practice Address - Street 1:6155 GRAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-1651
Practice Address - Country:US
Practice Address - Phone:847-535-7647
Practice Address - Fax:224-271-6642
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0245191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical