| Jiselle Roman Lcpc Pllc | |
|
10720 Princess Ave Chicago Ridge IL 60415-2139 | |
| (773) 627-7914 | |
| (708) 575-6527 |
| Full Name | Jiselle Roman Lcpc Pllc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 10720 Princess Ave, Chicago Ridge, Illinois |
| Authorized Official Name and Position | Jiselle Roman (LICENSED CLINICAL PROFESSIONAL COUN) |
| Authorized Official Contact | 7736277914 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jiselle Roman Lcpc Pllc 9631 S Cicero Ave # 1459 Oak Lawn IL 60453-3137 Ph: (773) 627-7914 | Jiselle Roman Lcpc Pllc 10720 Princess Ave Chicago Ridge IL 60415-2139 Ph: (773) 627-7914 |
| NPI Number | 1649917345 |
|---|---|
| Provider Enumeration Date | 05/16/2022 |
| Last Update Date | 11/04/2023 |
| Certification Date | 11/04/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649917345 | NPI | - | NPPES |
| 1750703583 | Other | IL | NPI 1 |
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