Provider Demographics
NPI:1275668477
Name:ARNOLD WEAVER, JENNIFER RUTH (LMFT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:RUTH
Last Name:ARNOLD WEAVER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 ROOSEVELT RD STE 230
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5734
Mailing Address - Country:US
Mailing Address - Phone:661-350-0337
Mailing Address - Fax:
Practice Address - Street 1:1804 SCHUBERT DR
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-3643
Practice Address - Country:US
Practice Address - Phone:661-350-0337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38071106H00000X
IL166001466106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist