Provider Demographics
NPI:1942367610
Name:JACOBEK, CHRISTINE L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:L
Last Name:JACOBEK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3402
Mailing Address - Country:US
Mailing Address - Phone:312-550-2628
Mailing Address - Fax:312-794-8997
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:312-550-2628
Practice Address - Fax:312-794-8997
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005024103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL366120Medicare ID - Type UnspecifiedMEDICARE REGISTRATION NO