Provider Demographics
NPI:1205931979
Name:FROBERG, JACQUELINE A (LCSW RN CADC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:A
Last Name:FROBERG
Suffix:
Gender:F
Credentials:LCSW RN CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 PRINCETON RD
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4743
Mailing Address - Country:US
Mailing Address - Phone:630-325-6649
Mailing Address - Fax:
Practice Address - Street 1:6262 KINGERY HWY
Practice Address - Street 2:SUITE 302
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-2985
Practice Address - Country:US
Practice Address - Phone:630-654-6660
Practice Address - Fax:630-654-1904
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5016101YA0400X
IL101YM0800X, 163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02225890OtherBLUE CROSS BLUE SHIELD