Healthcare Provider Details

I. General information

NPI: 1942139423
Provider Name (Legal Business Name): MARY JENNIFER WEBB LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 ROOSEVELT RD
OAK PARK IL
60304-2302
US

IV. Provider business mailing address

6200 ROOSEVELT RD
OAK PARK IL
60304-2302
US

V. Phone/Fax

Practice location:
  • Phone: 224-619-5065
  • Fax:
Mailing address:
  • Phone: 224-619-5065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.018229
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: