Provider Demographics
NPI:1841793361
Name:PROSPER PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:PROSPER PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:MARIE PATRICIA
Authorized Official - Last Name:FLECK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-908-9735
Mailing Address - Street 1:212 ELMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7507
Mailing Address - Country:US
Mailing Address - Phone:630-908-9735
Mailing Address - Fax:
Practice Address - Street 1:806 NORTH BLVD APT 202
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301
Practice Address - Country:US
Practice Address - Phone:630-908-9735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-11
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009375103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty