Provider Demographics
NPI:1871329417
Name:MCDOLE, JAYDA
Entity type:Individual
Prefix:
First Name:JAYDA
Middle Name:
Last Name:MCDOLE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3745 216TH PL
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2722
Mailing Address - Country:US
Mailing Address - Phone:708-439-1319
Mailing Address - Fax:
Practice Address - Street 1:700 CEDAR RIDGE LN
Practice Address - Street 2:
Practice Address - City:RICHTON PARK
Practice Address - State:IL
Practice Address - Zip Code:60471-2255
Practice Address - Country:US
Practice Address - Phone:773-875-1516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL23-313831106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician