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General NPI Number Information
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NPI Number | 1669245569
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Entity Type | Organization
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Legal Business Name | JENNY EVANS COUNSELING, LLC
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Dates
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Enumeration Date | 11/01/2023
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 8416 N KNOXVILLE AVE SUITE B PMB 1019
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City | PEORIA
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State | IL
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Zip | 61615
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Country | US
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Telephone | 847-612-9734
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Fax |
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Provider Business Mailing Address
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Address Line | 252 GRIMM RD
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City | CONGERVILLE
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State | IL
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Zip | 61729-9544
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Country | US
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Telephone | 847-612-9734
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER EVANS
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Credential | LCSW
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Telephone | 847-612-9734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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