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General NPI Number Information
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NPI Number | 1497275671
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Entity Type | Individual
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Provider Name | JEANNE KETT LCPC
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Gender | Female
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Dates
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Enumeration Date | 06/20/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 180 W PARK AVE STE 130
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City | ELMHURST
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State | IL
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Zip | 60126-3379
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Country | US
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Telephone | 312-800-9426
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1464
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City | ELMHURST
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State | IL
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Zip | 60126-8464
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Country | US
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Telephone | 312-800-9426
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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 | 180.001553
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License Number State | IL
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