Healthcare Provider Details

I. General information

NPI: 1487558722
Provider Name (Legal Business Name): JENNA DACQUEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 AUSTIN ST STE 312W
EVANSTON IL
60202-3443
US

IV. Provider business mailing address

800 AUSTIN ST STE 312W
EVANSTON IL
60202-3443
US

V. Phone/Fax

Practice location:
  • Phone: 847-868-8664
  • Fax:
Mailing address:
  • Phone: 847-868-8664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: