Healthcare Provider Details

I. General information

NPI: 1043073455
Provider Name (Legal Business Name): JENNIFER JEAN LYNCH PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 N OTTAWA ST STE 245
JOLIET IL
60432-4378
US

IV. Provider business mailing address

54 N OTTAWA ST STE 245
JOLIET IL
60432-4378
US

V. Phone/Fax

Practice location:
  • Phone: 815-396-8617
  • Fax: 815-201-8752
Mailing address:
  • Phone: 815-396-8617
  • Fax: 815-201-8752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277005999
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: