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General NPI Number Information
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NPI Number | 1134684939
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Entity Type | Organization
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Legal Business Name | JENNIFER HARRIS PSYD, LLC
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Dates
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Enumeration Date | 02/05/2019
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 2000 N RACINE AVE STE 2190
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City | CHICAGO
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State | IL
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Zip | 60614-7007
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Country | US
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Telephone | 773-598-9219
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Fax |
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Provider Business Mailing Address
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Address Line | 336 LATROBE AVE
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City | NORTHFIELD
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State | IL
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Zip | 60093-3519
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Country | US
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Telephone | 847-414-5656
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. JENNIFER HARRIS
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Credential | PSYD
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Telephone | 847-414-5656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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