Healthcare Provider Details

I. General information

NPI: 1245176916
Provider Name (Legal Business Name): MS. JENNA ANN DODOER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20550 S LAGRANGE RD STE 210
FRANKFORT IL
60423-1495
US

IV. Provider business mailing address

2622 PAR FOUR LN
JOLIET IL
60436-1070
US

V. Phone/Fax

Practice location:
  • Phone: 708-614-6860
  • Fax:
Mailing address:
  • Phone: 815-514-8340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: