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General NPI Number Information
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NPI Number | 1720010622
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Entity Type | Individual
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Provider Name | JENNY K PHILIPSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 09/08/2023
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Provider Practice Location Address
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Address Line | 636 CHURCH ST SUITE 601
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City | EVANSTON
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State | IL
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Zip | 60201
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Country | US
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Telephone | 847-644-2462
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Fax | 847-328-3703
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Provider Business Mailing Address
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Address Line | 606 SHERIDAN ROAD 1 W
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City | EVANSTON
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State | IL
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Zip | 60202
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Country | US
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Telephone | 847-644-2462
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Fax | 847-328-3703
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149009140
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 149009140
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License Number State | IL
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