MEDICARE: JENNICE WOOLEVER LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	178.021979	IL

General Provider Information

NPI Number	:	1023996188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNICE WOOLEVER LPC

Provider Business Mailing Address
First Line	:	1831 N KNOXVILLE AVE
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61603-3027
Country	:	US
Telephone Number	:	309-688-9282
Fax Number	:

Provider Business Practice Location Address
First Line	:	1831 N KNOXVILLE AVE
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61603-3027
Country	:	US
Telephone Number	:	309-688-9282
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2025
Last Update Date	:	08/25/2025

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Directions to “ JENNICE WOOLEVER LPC” Practice Location

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