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General NPI Number Information
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NPI Number | 1457520785
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Entity Type | Individual
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Provider Name | JENNIFER LEE FERGUSON CADC, LSW
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Gender | Female
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Dates
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Enumeration Date | 02/20/2008
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 1122 S 4TH ST
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City | MONMOUTH
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State | IL
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Zip | 61462-2734
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Country | US
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Telephone | 309-734-2813
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Fax |
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Provider Business Mailing Address
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Address Line | 1122 SOUTH 4TH STREET PAWPRINT PATHWAY COUNSELING, PLLC
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City | MONMOUTH
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State | IL
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Zip | 61462
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Country | US
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Telephone | 309-734-2813
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 26742
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34961
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 007831
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License Number State | IA
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.017885
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License Number State | IL
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