1730606575 NPI number — FJ PSYCHOLOGICAL SERVICES Dr Melissa Folk Jednoroz PsyD

Table of content: Dr Melissa Folk Jednoroz PsyD (NPI 1730606575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730606575 NPI number — FJ PSYCHOLOGICAL SERVICES Dr Melissa Folk Jednoroz PsyD

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
FJ PSYCHOLOGICAL SERVICES
Provider Last Name:
Folk Jednoroz
Provider First Name:
Melissa
Provider Middle Name:
Provider Name Prefix Text:
Dr
Provider Name Suffix Text:
PsyD
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730606575
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1127 ADAGIO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VOLO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60073-5908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
224-587-9128
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1127 Adagio Drive
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCHENRY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60050-5336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
224-587-9128
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2017

Additional Information

Authorized Official

Authorized Official Last Name:
FOLK-JEDNOROZ
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/THERAPIST
Authorized Official Telephone Number:
224-587-9128

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  071009064 , 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)





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