Healthcare Provider Details

I. General information

NPI: 1013745249
Provider Name (Legal Business Name): JANELLE KNIPPEN LCPC, R-DMT, RYT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 N TAMARAC BLVD
ADDISON IL
60101-1696
US

IV. Provider business mailing address

804 N TAMARAC BLVD
ADDISON IL
60101-1696
US

V. Phone/Fax

Practice location:
  • Phone: 773-827-7609
  • Fax:
Mailing address:
  • Phone: 773-827-7609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.018182
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: