Provider Demographics
NPI:1649331513
Name:ERICSON, JILL SHERYL (LCPC)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:SHERYL
Last Name:ERICSON
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 1:22852 HARBOUR LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544
Mailing Address - Country:US
Mailing Address - Phone:815-254-7511
Mailing Address - Fax:815-254-7512
Practice Address - Street 1:22852 HARBOUR LN
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544
Practice Address - Country:US
Practice Address - Phone:815-767-8395
Practice Address - Fax:815-254-7512
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional