Healthcare Provider Details

I. General information

NPI: 1558596833
Provider Name (Legal Business Name): JENNIFER R BOVEE LCSW, CRADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 KAYS DR STE C
NORMAL IL
61761-1979
US

IV. Provider business mailing address

405 KAYS DR STE C
NORMAL IL
61761-1979
US

V. Phone/Fax

Practice location:
  • Phone: 309-807-5077
  • Fax: 309-214-9679
Mailing address:
  • Phone: 309-807-5077
  • Fax: 309-214-9679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number149012901
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: