Provider Demographics
NPI:1649337320
Name:CHRISTINE L JACOBEK PSYD PC
Entity type:Organization
Organization Name:CHRISTINE L JACOBEK PSYD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JACOBEK
Authorized Official - Suffix:
Authorized Official - Credentials:PSY,D,
Authorized Official - Phone:312-726-2626
Mailing Address - Street 1:30 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3402
Mailing Address - Country:US
Mailing Address - Phone:312-726-2626
Mailing Address - Fax:312-794-8997
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:312-726-2626
Practice Address - Fax:312-794-8997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL366120Medicare ID - Type UnspecifiedMEDICARE REGISTRATION NO