Provider Demographics
NPI:1184064958
Name:ROBL, JARED RYAN (LCSW)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:RYAN
Last Name:ROBL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2537 N HAMLIN AVE
Mailing Address - Street 2:APT #1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1007
Mailing Address - Country:US
Mailing Address - Phone:316-648-1537
Mailing Address - Fax:
Practice Address - Street 1:2537 N HAMLIN AVE
Practice Address - Street 2:APT #1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-1007
Practice Address - Country:US
Practice Address - Phone:316-648-1537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490158061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical