Provider Demographics
NPI:1083754931
Name:THOMASON, JENNIFER MARIE (LCPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:THOMASON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:HARTRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:5259 S MILL POND RD
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-9136
Mailing Address - Country:US
Mailing Address - Phone:815-562-9509
Mailing Address - Fax:
Practice Address - Street 1:125 S 4TH ST
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:IL
Practice Address - Zip Code:61061-1609
Practice Address - Country:US
Practice Address - Phone:815-732-3157
Practice Address - Fax:815-732-3834
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2012-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health