Healthcare Provider Details

I. General information

NPI: 1447197769
Provider Name (Legal Business Name): JACQUELYN JENNINGS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 S 7TH ST
ST CHARLES IL
60174-3944
US

IV. Provider business mailing address

802 S 7TH ST
ST CHARLES IL
60174-3944
US

V. Phone/Fax

Practice location:
  • Phone: 805-320-5972
  • Fax: 805-320-5972
Mailing address:
  • Phone: 805-320-5972
  • Fax: 805-320-5972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.025048
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: