Provider Demographics
NPI:1205134822
Name:LEVINSKY, JILL M (PSYD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:M
Last Name:LEVINSKY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 E MAIN ST
Mailing Address - Street 2:#405
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2205
Mailing Address - Country:US
Mailing Address - Phone:331-222-7915
Mailing Address - Fax:
Practice Address - Street 1:1121 E MAIN ST
Practice Address - Street 2:#405
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2205
Practice Address - Country:US
Practice Address - Phone:331-222-7915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-06
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007552103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical