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General NPI Number Information
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NPI Number | 1891252490
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Entity Type | Individual
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Provider Name | JENEANE KRISCHAK
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Gender | Female
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Dates
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Enumeration Date | 03/01/2019
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Last Update Date | 03/01/2019
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Provider Practice Location Address
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Address Line | 1900 W POLK ST
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City | CHICAGO
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State | IL
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Zip | 60612-3723
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Country | US
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Telephone | 773-593-5013
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Fax |
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Provider Business Mailing Address
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Address Line | 2405 SIOUX AVE
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City | WOODRIDGE
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State | IL
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Zip | 60517-2310
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Country | US
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Telephone |
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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 | 178010988
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180011161
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License Number State |
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