Healthcare Provider Details

I. General information

NPI: 1518299106
Provider Name (Legal Business Name): JENNIFER RENEE GRIFFIN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 06/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W BELMONT AVE SUITE 400
CHICAGO IL
60657-3200
US

IV. Provider business mailing address

4250 N MOZART ST APT 3S
CHICAGO IL
60618-1785
US

V. Phone/Fax

Practice location:
  • Phone: 312-505-5579
  • Fax:
Mailing address:
  • Phone: 312-505-5579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180.008218
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178006361
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178006361
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number178006361
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: