Provider Demographics
NPI:1700471539
Name:MEYERSON, JORDYN (LPC)
Entity Type:Individual
Prefix:MISS
First Name:JORDYN
Middle Name:
Last Name:MEYERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1852 CLOVERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2106
Mailing Address - Country:US
Mailing Address - Phone:847-708-3657
Mailing Address - Fax:
Practice Address - Street 1:1852 CLOVERDALE AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2106
Practice Address - Country:US
Practice Address - Phone:847-708-3657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.016759101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty