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NPI Code Detail

MEDICARE: STEVEN L JENNINGS JR. M.A.

MEDICARE: STEVEN L JENNINGS JR. M.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1881244150
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEVEN L JENNINGS JR. M.A.
Provider Business Mailing Address
First Line : 2950 W CHICAGO AVE STE 202
Second Line :
City : CHICAGO
State : IL
Zip : 60622-4377
Country : US
Telephone Number : 312-625-6604
Fax Number :
Provider Business Practice Location Address
First Line : 2950 W CHICAGO AVE STE 202
Second Line :
City : CHICAGO
State : IL
Zip : 60622-4377
Country : US
Telephone Number : 312-625-6604
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2019
Last Update Date : 07/19/2022

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