Provider Demographics
NPI:1952475758
Name:SPIETH, JESSICA D (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:D
Last Name:SPIETH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 OAKWOOD DR
Mailing Address - Street 2:3B
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3084
Mailing Address - Country:US
Mailing Address - Phone:630-964-6514
Mailing Address - Fax:630-964-6514
Practice Address - Street 1:10735 S CICERO AVE
Practice Address - Street 2:STE. 208
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-5400
Practice Address - Country:US
Practice Address - Phone:708-424-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional