Provider Demographics
NPI:1255982385
Name:MISKEVICS, JONATHAN (LPC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:MISKEVICS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15130 EL CAMENO REAL DR APT 1S
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3007
Mailing Address - Country:US
Mailing Address - Phone:708-257-5382
Mailing Address - Fax:
Practice Address - Street 1:5210 W 95TH ST STE 201
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3792
Practice Address - Country:US
Practice Address - Phone:708-529-9166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178013026101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor