MEDICARE: JENNIFER J DUGAN MA

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	103TS0200X	School Psychologist	1687032	IL

General Provider Information

NPI Number	:	1881318848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER J DUGAN MA

Provider Business Mailing Address
First Line	:	1500 S SANGAMON ST
Second Line	:
City	:	CRETE
State	:	IL
Zip	:	60417-2831
Country	:	US
Telephone Number	:	708-367-2642
Fax Number	:

Provider Business Practice Location Address
First Line	:	25425 S WILL CENTER RD
Second Line	:
City	:	MONEE
State	:	IL
Zip	:	60449-9814
Country	:	US
Telephone Number	:	708-367-2600
Fax Number	:

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

Provider Enumeration Date	:	10/03/2022
Last Update Date	:	10/03/2022

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