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General NPI Number Information
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NPI Number | 1932859063
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Entity Type | Individual
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Provider Name | JENNIFER LEE DYKEMAN NCC, LPC
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Gender | Female
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Dates
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Enumeration Date | 03/23/2022
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 525 S WASHINGTON ST STE 23
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City | NAPERVILLE
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State | IL
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Zip | 60540-6750
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Country | US
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Telephone | 630-399-2306
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Fax |
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Provider Business Mailing Address
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Address Line | 1715 WETHERBY CT N
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City | STERLING
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State | IL
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Zip | 61081-9697
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Country | US
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Telephone | 630-399-2306
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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 | 178012121
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License Number State | IL
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