Healthcare Provider Details

I. General information

NPI: 1376779983
Provider Name (Legal Business Name): JENNIFER FIFE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 SUNSET RD
WINNETKA IL
60093-4124
US

IV. Provider business mailing address

530 SUNSET RD
WINNETKA IL
60093-4124
US

V. Phone/Fax

Practice location:
  • Phone: 847-563-4143
  • Fax: 815-642-0662
Mailing address:
  • Phone: 847-563-4143
  • Fax: 815-642-0662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.006790
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: