Healthcare Provider Details

I. General information

NPI: 1871413898
Provider Name (Legal Business Name): JENNIE ANDERSEN-DRAKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SEMINARY AVE
AURORA IL
60505-4768
US

IV. Provider business mailing address

500 TOMCAT LN
AURORA IL
60505-5006
US

V. Phone/Fax

Practice location:
  • Phone: 630-299-8071
  • Fax:
Mailing address:
  • Phone: 630-299-8071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2060228
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: