Provider Demographics
NPI:1619305711
Name:FREILICH, JESSICA HEIMAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:HEIMAN
Last Name:FREILICH
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 1:899 SKOKIE BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4022
Mailing Address - Country:US
Mailing Address - Phone:847-559-3240
Mailing Address - Fax:
Practice Address - Street 1:899 SKOKIE BLVD STE 204
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4022
Practice Address - Country:US
Practice Address - Phone:847-559-3240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008498103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical