Basic Information
| Provider Information | |||||||||
| NPI: | 1154743078 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAEGERS | ||||||||
| FirstName: | RENEE | ||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3836 KNOLLWOOD LN | ||||||||
| Address2: | |||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600252408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477295393 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3080 WEST LAKE AVENUE | ||||||||
| Address2: | YOUTH SERVICES GLENVIEW/NORTHBROOK | ||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477242620 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2014 | ||||||||
| LastUpdateDate: | 06/11/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 180.008604 | IL | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.