Healthcare Provider Details

I. General information

NPI: 1700333945
Provider Name (Legal Business Name): JENNIFER BERGHORN CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 MOON LAKE BLVD
HOFFMAN ESTATES IL
60169-1010
US

IV. Provider business mailing address

1776 MOON LAKE BLVD
HOFFMAN ESTATES IL
60169-1010
US

V. Phone/Fax

Practice location:
  • Phone: 847-882-4181
  • Fax: 847-882-4299
Mailing address:
  • Phone: 847-882-4181
  • Fax: 847-882-4299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: