Individual
JILLIAN MCCAMMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
50 NORTHGATE INDUSTRIAL DR, GRANITE CITY, IL 62040-6805
(618) 877-4420
Mailing address
448 WYLIE DR, NORMAL, IL 61761-5405
(888) 924-3786
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
178.018113
IL
101Y00000X
Counselor
270000278
IL
101YP2500X
Professional Counselor
178018113
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4A00-IPI-032
—
IL
Enumeration date
08/30/2020
Last updated
08/17/2023
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