Healthcare Provider Details

I. General information

NPI: 1821703091
Provider Name (Legal Business Name): JENNIFER HU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 W JACKSON BLVD STE 1624
CHICAGO IL
60604-3743
US

IV. Provider business mailing address

1147 W OHIO ST STE 103
CHICAGO IL
60642-5874
US

V. Phone/Fax

Practice location:
  • Phone: 872-262-7192
  • Fax:
Mailing address:
  • Phone: 312-772-9796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149025271
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: