Provider Demographics
NPI:1053692608
Name:HITCHINS, JAMIE RAE
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:RAE
Last Name:HITCHINS
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 1:2908 CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6492
Mailing Address - Country:US
Mailing Address - Phone:815-260-1244
Mailing Address - Fax:
Practice Address - Street 1:2908 CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6492
Practice Address - Country:US
Practice Address - Phone:815-260-1244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YS0200X
IL1-14-15083103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool