Provider Demographics
NPI:1194699934
Name:HAWKINS, JEROME TYSHON
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:TYSHON
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 PLUM ST APT 211
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-3447
Mailing Address - Country:US
Mailing Address - Phone:630-486-5813
Mailing Address - Fax:630-486-5813
Practice Address - Street 1:708 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1105
Practice Address - Country:US
Practice Address - Phone:630-966-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health