1528336328 NPI number — JESSICA FOX LEVY LCPC

Table of content: JESSICA FOX LEVY LCPC (NPI 1528336328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528336328 NPI number — JESSICA FOX LEVY LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOX LEVY
Provider First Name:
JESSICA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FOX
Provider Other First Name:
JESSICA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528336328
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36 MAIN STREET, SUITE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARK RIDGE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-545-0500
Provider Business Mailing Address Fax Number:
888-440-2577

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
PARK RIDGE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-545-0500
Provider Business Practice Location Address Fax Number:
888-440-2577
Provider Enumeration Date:
12/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  180.007767 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP1600X , with the licence number: 180.007767 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com