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Individual

JODI RANDLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
737 W CORNELIA AVE UNIT G, CHICAGO, IL 60657-2459
(773) 818-5875
Mailing address
737 W CORNELIA AVE UNIT G, CHICAGO, IL 60657-2459
(773) 818-5875

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
33845
IL
101YP2500X
Professional Counselor
Primary
178.013030
IL

Other

Enumeration date
12/04/2018
Last updated
12/04/2018
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