Provider Demographics
NPI:1043957939
Name:DEVOLDER, JAMI
Entity type:Individual
Prefix:
First Name:JAMI
Middle Name:
Last Name:DEVOLDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2518 N LAKE DR APT 5
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-3810
Mailing Address - Country:US
Mailing Address - Phone:708-728-5834
Mailing Address - Fax:
Practice Address - Street 1:5239 N CLARK ST # 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2122
Practice Address - Country:US
Practice Address - Phone:708-320-3095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180014308101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health