Healthcare Provider Details

I. General information

NPI: 1609785518
Provider Name (Legal Business Name): DANA LYNN FENCEROY MA IN MENTAL HEALTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 DEMPSTER ST
EVANSTON IL
60202-1017
US

IV. Provider business mailing address

2722 N MARSHFIELD AVE
CHICAGO IL
60614-1016
US

V. Phone/Fax

Practice location:
  • Phone: 847-322-8141
  • Fax:
Mailing address:
  • Phone: 847-322-8141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178023344
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: