Healthcare Provider Details

I. General information

NPI: 1841430287
Provider Name (Legal Business Name): JENNIFER NICOLETTI LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER BEISNER LCPC

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1288 RICKERT DR STE 201
NAPERVILLE IL
60540-8901
US

IV. Provider business mailing address

64 N GOLFVIEW CT
GLENDALE HEIGHTS IL
60139-3655
US

V. Phone/Fax

Practice location:
  • Phone: 630-428-7890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180004441
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: