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General NPI Number Information
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NPI Number | 1962022194
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Entity Type | Individual
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Provider Name | JENNIFER ANN WEAVER CADC
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Gender | Female
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Dates
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Enumeration Date | 04/17/2020
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 9845 W ROOSEVELT RD
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City | WESTCHESTER
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State | IL
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Zip | 60154-2758
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Country | US
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Telephone | 708-786-2059
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Fax |
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Provider Business Mailing Address
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Address Line | 8803 OGDEN AVE
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City | BROOKFIELD
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State | IL
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Zip | 60513-2158
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Country | US
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Telephone | 708-990-8505
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | IL
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