Provider Demographics
NPI:1376728964
Name:JANSSEN, JAMIE JO (PSYD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:JO
Last Name:JANSSEN
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 1:1632 W COLONIAL PKWY STE 204
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:IL
Mailing Address - Zip Code:60067-4725
Mailing Address - Country:US
Mailing Address - Phone:170-836-3333
Mailing Address - Fax:
Practice Address - Street 1:1632 W COLONIAL PKWY STE 204
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:IL
Practice Address - Zip Code:60067-4725
Practice Address - Country:US
Practice Address - Phone:708-363-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010156103TC0700X
IL071010156103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty