Provider Demographics
NPI:1891453502
Name:HOUSEMAN, JAMIE LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:HOUSEMAN
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 1:304 FERRIS ST
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-1012
Mailing Address - Country:US
Mailing Address - Phone:630-205-2238
Mailing Address - Fax:
Practice Address - Street 1:121 S 4TH ST
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:IL
Practice Address - Zip Code:61061-1628
Practice Address - Country:US
Practice Address - Phone:815-501-2088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490204381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical