MEDICARE: JENNIFER HARRIS PSYD, LLC

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	103TC0700X	Clinical Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1881055499	OTHER		NPI

General Provider Information

NPI Number	:	1134684939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER HARRIS PSYD, LLC

Provider Business Mailing Address
First Line	:	336 LATROBE AVE
Second Line	:
City	:	NORTHFIELD
State	:	IL
Zip	:	60093-3519
Country	:	US
Telephone Number	:	847-414-5656
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 N RACINE AVE STE 2190
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-7007
Country	:	US
Telephone Number	:	773-598-9219
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. JENNIFER HARRIS
Credential	:	PSYD
Telephone Number	:	847-414-5656

Provider Enumeration Date	:	02/05/2019
Last Update Date	:	08/03/2022

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