Healthcare Provider Details

I. General information

NPI: 1194602581
Provider Name (Legal Business Name): JEN WOODRUM COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 E WASHINGTON ST STE 3E
BLOOMINGTON IL
61701-4365
US

IV. Provider business mailing address

2103 E WASHINGTON ST STE 3E
BLOOMINGTON IL
61701-4365
US

V. Phone/Fax

Practice location:
  • Phone: 309-271-7042
  • Fax: 309-322-8894
Mailing address:
  • Phone: 309-271-7042
  • Fax: 309-322-8894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER WOODRUM
Title or Position: THERAPIST
Credential: MS, LCPC
Phone: 224-217-0151