Healthcare Provider Details

I. General information

NPI: 1275135204
Provider Name (Legal Business Name): JENNIFER MARIE DOYLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8311 ROOSEVELT RD
FOREST PARK IL
60130-2500
US

IV. Provider business mailing address

733 N LOMBARD AVE
OAK PARK IL
60302-1721
US

V. Phone/Fax

Practice location:
  • Phone: 708-771-7000
  • Fax:
Mailing address:
  • Phone: 312-927-9076
  • Fax: 708-488-4965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149013014
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: