Provider Demographics
NPI:1972663219
Name:PEKAREK KROHN, JAMIE SUZANNE (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:SUZANNE
Last Name:PEKAREK KROHN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 W FOSTER AVE
Mailing Address - Street 2:3W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2260
Mailing Address - Country:US
Mailing Address - Phone:773-506-9224
Mailing Address - Fax:
Practice Address - Street 1:155 N MICHIGAN AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7511
Practice Address - Country:US
Practice Address - Phone:312-238-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636614OtherBCBSIL