Healthcare Provider Details

I. General information

NPI: 1720010622
Provider Name (Legal Business Name): JENNY K PHILIPSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNY P LEWIS M.A., L.C.S.W.

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/08/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 CHURCH ST SUITE 601
EVANSTON IL
60201
US

IV. Provider business mailing address

606 SHERIDAN ROAD 1 W
EVANSTON IL
60202
US

V. Phone/Fax

Practice location:
  • Phone: 847-644-2462
  • Fax: 847-328-3703
Mailing address:
  • Phone: 847-644-2462
  • Fax: 847-328-3703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number149009140
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149009140
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: