Provider Demographics
NPI:1194012237
Name:FOLEY, JENNIFER B
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:B
Last Name:FOLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1448 N MILWAUKEE AVE
Mailing Address - Street 2:201
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-9225
Mailing Address - Country:US
Mailing Address - Phone:312-324-4283
Mailing Address - Fax:
Practice Address - Street 1:1448 N MILWAUKEE AVE
Practice Address - Street 2:201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-9225
Practice Address - Country:US
Practice Address - Phone:312-324-4283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006510101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1616824OtherBLUE CROSS BLUE SHIELD