Provider Demographics
NPI:1265944029
Name:JEANETTE SIMON, PSY.D., C.A.D.C., LLC
Entity type:Organization
Organization Name:JEANETTE SIMON, PSY.D., C.A.D.C., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:ZWICKY
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, CADC
Authorized Official - Phone:708-628-7578
Mailing Address - Street 1:1100 LAKE ST STE 201B
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1028
Mailing Address - Country:US
Mailing Address - Phone:708-628-7578
Mailing Address - Fax:
Practice Address - Street 1:1100 LAKE ST STE 210B
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1015
Practice Address - Country:US
Practice Address - Phone:708-628-7578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4778103TA0400X
IL071005823103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty