Provider Demographics
NPI:1356755540
Name:AKBAR, JAMILAH
Entity type:Individual
Prefix:
First Name:JAMILAH
Middle Name:
Last Name:AKBAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7339 WOODWARD AVE
Mailing Address - Street 2:306
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-2576
Mailing Address - Country:US
Mailing Address - Phone:312-330-1936
Mailing Address - Fax:
Practice Address - Street 1:7339 WOODWARD AVE
Practice Address - Street 2:306
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2576
Practice Address - Country:US
Practice Address - Phone:312-330-1936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009191101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health