Provider Demographics
NPI:1003102484
Name:COCA, JENNA MARIE (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:COCA
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 OAKWOOD TER
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2840
Mailing Address - Country:US
Mailing Address - Phone:847-253-9769
Mailing Address - Fax:
Practice Address - Street 1:1010 JORIE BLVD
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2215
Practice Address - Country:US
Practice Address - Phone:630-506-3906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2022-09-08
Deactivation Date:2022-08-18
Deactivation Code:
Reactivation Date:2022-09-07
Provider Licenses
StateLicense IDTaxonomies
IL180.009254101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor