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General NPI Number Information
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NPI Number | 1417643503
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Entity Type | Organization
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Legal Business Name | JENNIFER BOOTH PSYD PLLC
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Dates
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Enumeration Date | 04/12/2023
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Last Update Date | 06/07/2023
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Provider Practice Location Address
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Address Line | 1409 W IRVING PARK RD
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City | CHICAGO
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State | IL
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Zip | 60613-1920
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Country | US
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Telephone | 224-636-4942
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Fax |
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Provider Business Mailing Address
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Address Line | 1929 W HENDERSON ST REAR
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City | CHICAGO
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State | IL
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Zip | 60657-6666
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Country | US
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Telephone | 224-636-4942
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | JENNIFER L CORLEY
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Credential | PSYD
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Telephone | 224-636-4942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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