Provider Demographics
NPI:1013216365
Name:CLECKNER, JENNIFER M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:M
Last Name:CLECKNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:DOWLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:240 E LAKE ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-2890
Mailing Address - Country:US
Mailing Address - Phone:312-965-0588
Mailing Address - Fax:
Practice Address - Street 1:501 W STATE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2149
Practice Address - Country:US
Practice Address - Phone:312-965-0588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0117831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical