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General NPI Number Information
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NPI Number | 1508041807
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Entity Type | Individual
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Provider Name | JENNIFER LARSON M.A., LCPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 01/04/2008
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Last Update Date | 08/07/2013
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Provider Practice Location Address
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Address Line | 25 E WASHINGTON ST STE 1406
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City | CHICAGO
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State | IL
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Zip | 60602-1820
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Country | US
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Telephone | 773-398-0359
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Fax | 773-989-7207
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Provider Business Mailing Address
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Address Line | 5142 N LEAVITT ST STE 2
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City | CHICAGO
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State | IL
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Zip | 60625-6829
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Country | US
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Telephone | 773-398-0359
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Fax | 773-989-7207
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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 | 180006534
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License Number State | IL
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