Provider Demographics
NPI:1720794902
Name:HOFSTETTER, JACLYN (MS, LPC-IT)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:HOFSTETTER
Suffix:
Gender:F
Credentials:MS, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7305 POPLAR LN
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-4251
Mailing Address - Country:US
Mailing Address - Phone:630-432-3147
Mailing Address - Fax:
Practice Address - Street 1:2600 WARRENVILLE RD STE 205
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1761
Practice Address - Country:US
Practice Address - Phone:847-477-8244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7173-226101YP2500X
IL178.019354101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional