Provider Demographics
NPI:1902046352
Name:STORCH, JESSICA (LPC)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:STORCH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5227 MAIN ST
Mailing Address - Street 2:#23
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-4646
Mailing Address - Country:US
Mailing Address - Phone:630-915-3946
Mailing Address - Fax:
Practice Address - Street 1:415 W 8TH ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-4451
Practice Address - Country:US
Practice Address - Phone:630-323-7500
Practice Address - Fax:630-323-7510
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178003839101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health