Active NPI
Jennifer M Reilley
- Professional Counselor
- Chicago, IL
National Provider Identifier
1962911297
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 178009882
- Practice address
- 1 E Superior St Ste 410
Chicago, IL 60611-2596 - Phone
- (630) 606-2569
- NPI assigned
- Sep 29, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178009882 | IL | Primary |
Addresses
Primary practice location
1 E Superior St Ste 410
Chicago, IL 60611-2596
Mailing address
10849 S Hamlin Ave
Chicago, IL 60655-3916
Phone (630) 606-2569
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178009882 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506643200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1506643200000",
"number": "1962911297",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10849 S HAMLIN AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606553916",
"telephone_number": "630-606-2569"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 E SUPERIOR ST STE 410",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606112596",
"telephone_number": "630-606-2569"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REILLEY",
"first_name": "JENNIFER",
"middle_name": "M",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-29",
"last_updated": "2017-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178009882",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.