Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 149011966 | IL |
NPI | 1003219627 |
---|---|
Provider Name | Jennifer Elana Jenks |
First Address | Oak Park, IL 60302-1710 |
Second Address | Skokie, IL 60077-2158 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2014 |
Last Update Date | 28/09/2014 |