Healthcare Provider Details

I. General information

NPI: 1609205996
Provider Name (Legal Business Name): JENNIFER MARIE NOAR LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MARIE THOMAS LPC

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 N KNOXVILLE AVE
PEORIA IL
61603-2414
US

IV. Provider business mailing address

6615 N. BIG HOLLOW RD. THE ANTIOCH GROUP
PEORIA IL
61554-2451
US

V. Phone/Fax

Practice location:
  • Phone: 309-687-7774
  • Fax:
Mailing address:
  • Phone: 309-692-6622
  • Fax: 309-692-6952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.009373
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: