| Doctor Name: | KATHRYN B JACK |
| NPI Number: | 1083768642 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC |
| License Number: | 180005428 |
| Business Practice Address: | 490 E Roosevelt Rd Ste 205 West Chicago, IL - 601853901 |
| Business Phone Number: | 6307790972 |
| Business Fax Number: | |
| Mailing Address: | 490 E Roosevelt Rd Ste 205, WEST CHICAGO |
| State: | IL |
| Postal Code: | 601853901 |
| Phone Number: | 6307790972 |
| Fax Number: | |
| NPI Enumeration Date: | 01/22/2007 |
| NPI Last Update Date: | 12/20/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 180005428 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |