Individual
JESSICA LEE LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS-MFT, ALMFT
Contact information
Practice address
5290 WILLIAMS DR, ROSCOE, IL 61073-9222
(815) 324-0324
Mailing address
8616 SCOTT LN, MACHESNEY PARK, IL 61115-2586
(815) 914-0063
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
208.00854
IL
Other
Enumeration date
10/01/2020
Last updated
11/16/2020
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