| Doctor Name: | DR. JESSICA MIKULECKY |
| NPI Number: | 1104247709 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSYD |
| License Number: | 178.009650 |
| Business Practice Address: | 11800 S 75th Ave Third Floor Palos Heights, IL - 604631033 |
| Business Phone Number: | 7086718440 |
| Business Fax Number: | 7086718446 |
| Mailing Address: | 11800 S 75th Ave, Third Floor PALOS HEIGHTS |
| State: | IL |
| Postal Code: | 604631033 |
| Phone Number: | 7086718440 |
| Fax Number: | 7086718446 |
| NPI Enumeration Date: | 12/27/2013 |
| NPI Last Update Date: | 12/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 178.009650 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |