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General NPI Number Information
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NPI Number | 1104357888
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Entity Type | Individual
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Provider Name | JENNIFER MENEGON LCPC
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Gender | Female
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Dates
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Enumeration Date | 03/23/2017
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Last Update Date | 03/25/2017
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Provider Practice Location Address
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Address Line | 1301 PYOTT RD SUITE 207
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City | LAKE IN THE HILLS
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State | IL
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Zip | 60156-9794
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Country | US
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Telephone | 224-387-8506
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Fax |
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Provider Business Mailing Address
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Address Line | 2283 SUNSET DR
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City | INVERNESS
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State | IL
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Zip | 60067
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Country | US
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Telephone | 847-754-5169
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.005684
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License Number State | IL
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