Provider Demographics
NPI:1124362736
Name:JENNIFER S LONOSKY PSYD
Entity Type:Organization
Organization Name:JENNIFER S LONOSKY PSYD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:S
Authorized Official - Last Name:LONOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-362-5601
Mailing Address - Street 1:1105 W PARK AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2567
Mailing Address - Country:US
Mailing Address - Phone:847-362-5601
Mailing Address - Fax:847-362-5611
Practice Address - Street 1:1105 W PARK AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2567
Practice Address - Country:US
Practice Address - Phone:847-362-5601
Practice Address - Fax:847-362-5611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-006522103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty