Healthcare Provider Details

I. General information

NPI: 1346482494
Provider Name (Legal Business Name): JENNA MICHELLE COLLINS-REED LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 10/04/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 GLEN ED PROFESSIONAL PARK
GLEN CARBON IL
62034-3333
US

IV. Provider business mailing address

6805 IL 162 SUITE 201
MARYVILLE IL
62062
US

V. Phone/Fax

Practice location:
  • Phone: 618-806-4205
  • Fax: 618-288-7398
Mailing address:
  • Phone: 618-288-5019
  • Fax: 618-288-5059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149012819
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: