Individual
MS. JACKIE LYNN BOUSEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATR, LCPC
Contact information
Practice address
2302 W NORTH AVE, #1E, CHICAGO, IL 60647-6260
(708) 320-8992
Mailing address
2302 W NORTH AVE, #1E, CHICAGO, IL 60647-6260
(708) 320-8992
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
178.009703
IL
101YP2500X
Professional Counselor
Primary
180010087
IL
Other
Enumeration date
11/10/2014
Last updated
11/05/2016
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