Basic Information
| Provider Information | |||||||||
| NPI: | 1568926079 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEIN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | SHEILA | ||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 910 ROOSEVELT RD | ||||||||
| Address2: | |||||||||
| City: | GLEN ELLYN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601377829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154691500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 910 ROOSEVELT RD | ||||||||
| Address2: | |||||||||
| City: | GLEN ELLYN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601377829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154691500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2019 | ||||||||
| LastUpdateDate: | 05/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 178.014570 | IL | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | 180.014409 | IL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.