Healthcare Provider Details

I. General information

NPI: 1720282437
Provider Name (Legal Business Name): JENNIFER L FRANCIS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 S WOOD ST MC 913
CHICAGO IL
60612-4300
US

IV. Provider business mailing address

912 S WOOD ST MC 913
CHICAGO IL
60612-4300
US

V. Phone/Fax

Practice location:
  • Phone: 312-413-8171
  • Fax:
Mailing address:
  • Phone: 312-413-8171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number71008174
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number71008174
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number4125
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number71008174
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: