Provider Demographics
NPI:1295020568
Name:JLSPENCER LTD
Entity Type:Organization
Organization Name:JLSPENCER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-409-9700
Mailing Address - Street 1:16001 PALM DR
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-0780
Mailing Address - Country:US
Mailing Address - Phone:815-834-0585
Mailing Address - Fax:
Practice Address - Street 1:16001 PALM DR
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-0780
Practice Address - Country:US
Practice Address - Phone:815-834-0585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006284103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty