Active NPI
Jaclyn Rovner, CRC, LCPC
- Professional Counselor
- Gurnee, IL
National Provider Identifier
1407259856
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180.016538
- Practice address
- 5101 Washington St Ste 1102
Gurnee, IL 60031-2988 - Phone
- (847) 975-1009
- NPI assigned
- Sep 30, 2014
- Reactivated
- Aug 18, 2017
- Last updated
- Nov 14, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180.016538 | IL | Primary |
| Behavior Analyst | 103K00000X | NU |
Addresses
Primary practice location
5101 Washington St Ste 1102
Gurnee, IL 60031-2988
Mailing address
625 Slawin Court
Mt Prospect, IL 60056
Phone (847) 789-7155
Other practice location 1
625 Slawin Court
Mt Prospect, IL 60056
Phone (847) 789-7155
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180.016538 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Collaborative Counseling Group of Illinois PLLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Clinical Social Worker
- Mundelein, IL
- NPI 1730810318
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1412035200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731542400000",
"number": "1407259856",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "625 SLAWIN COURT",
"city": "MT PROSPECT",
"state": "IL",
"postal_code": "60056",
"telephone_number": "847-789-7155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5101 WASHINGTON ST STE 1102",
"city": "GURNEE",
"state": "IL",
"postal_code": "600312988",
"telephone_number": "847-975-1009"
}
],
"practiceLocations": [
{
"address_1": "625 Slawin Court",
"address_purpose": "LOCATION",
"city": "Mt Prospect",
"state": "IL",
"postal_code": "60056",
"country_code": "US",
"telephone_number": "847-789-7155",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROVNER",
"first_name": "JACLYN",
"credential": "CRC, LCPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-09-30",
"last_updated": "2024-11-14",
"certification_date": "2024-11-14",
"deactivation_date": "2015-09-15",
"reactivation_date": "2017-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180.016538",
"primary": true
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gurnee, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.