Provider Demographics
NPI:1861980963
Name:HENRIKSON, JAMIE LYNN (LCPC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:HENRIKSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 E LINCOLN HWY # 1
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-3990
Mailing Address - Country:US
Mailing Address - Phone:779-777-7933
Mailing Address - Fax:
Practice Address - Street 1:1500 E LINCOLN HWY # 1
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-3990
Practice Address - Country:US
Practice Address - Phone:779-777-7933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180013321101YP2500X
IL178.007865101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional