Healthcare Provider Details

I. General information

NPI: 1528007945
Provider Name (Legal Business Name): JENNIFER FRIEDMAN M.D., LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 VALLEY RD
GLENCOE IL
60022-1660
US

IV. Provider business mailing address

661 VALLEY RD
GLENCOE IL
60022-1660
US

V. Phone/Fax

Practice location:
  • Phone: 312-246-9300
  • Fax:
Mailing address:
  • Phone: 312-246-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.014169
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.013462
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-101491
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: