Individual
JACOB RYAN PRITCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
3400 W NEW LEAF LN, PEORIA, IL 61615-3311
(309) 671-8000
Mailing address
2802 N WOODBINE TER, PEORIA, IL 61604-2126
(309) 642-4775
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
180009401
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180009401
ILLINOIS
IL
Enumeration date
02/26/2015
Last updated
02/15/2020
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