Healthcare Provider Details

I. General information

NPI: 1558596833
Provider Name (Legal Business Name): JENNIFER R BOVEE LCSW, CRADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N WILLIAMSBURG DR
BLOOMINGTON IL
61704-7705
US

IV. Provider business mailing address

207 N WILLIAMSBURG DR
BLOOMINGTON IL
61704-7705
US

V. Phone/Fax

Practice location:
  • Phone: 309-807-5077
  • Fax: 309-214-9679
Mailing address:
  • Phone: 309-807-5077
  • Fax: 309-214-9679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149012901
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: