Basic Information
| Provider Information | |||||||||
| NPI: | 1154514115 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RISKER | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | EMELIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5476 W HIGGINS AVE UNIT GE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606302176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7733168693 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 31480 N HIGHWAY 45 | ||||||||
| Address2: | |||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476802715 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2007 | ||||||||
| LastUpdateDate: | 05/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | 180008062 | IL | N | Behavioral Health & Social Service Providers | Psychologist | Counseling | 103TC1900X | 178.004967 | IL | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.