Provider Demographics
NPI:1912378944
Name:JON DODDS PHD LCPC LTD
Entity Type:Organization
Organization Name:JON DODDS PHD LCPC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DODDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCPC
Authorized Official - Phone:815-935-5053
Mailing Address - Street 1:750 ALMAR PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2315
Mailing Address - Country:US
Mailing Address - Phone:815-935-5053
Mailing Address - Fax:815-614-3617
Practice Address - Street 1:750 ALMAR PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2315
Practice Address - Country:US
Practice Address - Phone:815-935-5053
Practice Address - Fax:815-614-3617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005114101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty