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General NPI Number Information
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NPI Number | 1386192177
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Entity Type | Individual
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Provider Name | JENNIFER K CARLSON PHD
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Gender | Female
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Dates
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Enumeration Date | 09/21/2016
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 4046 N CLARENDON AVE APT 3N
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City | CHICAGO
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State | IL
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Zip | 60613-2300
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Country | US
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Telephone | 262-497-2488
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Fax |
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Provider Business Mailing Address
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Address Line | 1920 BRIARCLIFF RD NE
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City | ATLANTA
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State | GA
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Zip | 30329-4010
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Country | US
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Telephone | 404-785-4927
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071.009836
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.009836
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY.0006727
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License Number State | CO
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