Provider Demographics
NPI:1487218772
Name:AVERY, JADE (MD)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:AVERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2954
Mailing Address - Country:US
Mailing Address - Phone:312-695-5060
Mailing Address - Fax:312-695-5010
Practice Address - Street 1:676 N SAINT CLAIR ST STE 1100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2954
Practice Address - Country:US
Practice Address - Phone:312-695-5060
Practice Address - Fax:312-695-5010
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3087382084P0800X
IL0361687662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry