Jediola, Kassandra

Jediola, Kassandra is an individual health care provider with primary practice located at 631 S 1St St , Dekalb IL 60115-4117. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Jediola, Kassandra can be contacted via phone (815) 756-8501.

Contact Information

Primary practice address
631 S 1St St Dekalb IL 60115-4117
Phone: (815) 756-8501
Fax: (815) 756-2944
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 149.017240 Illinois

Profile Details

NPI number 1427322130
LBN Legal business name Jediola, Kassandra
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 27th, 2012
Last updated Jan 26th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1427322130 NPPES
Illinois MEDICAID 474579189001

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