Provider Demographics
NPI:1316215056
Name:OLDEN, JENNIFER LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:OLDEN
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Gender:F
Credentials:LCSW
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Mailing Address - Street 1:3001 GREEN BAY RD
Mailing Address - Street 2:CAPT JAMES A. LOVELL FEDERAL HEALTH CARE CENTER
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-3048
Mailing Address - Country:US
Mailing Address - Phone:224-610-4846
Mailing Address - Fax:224-610-3863
Practice Address - Street 1:3001 GREEN BAY RD
Practice Address - Street 2:CAPT JAMES A. LOVELL FEDERAL HEALTH CARE CENTER
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3048
Practice Address - Country:US
Practice Address - Phone:224-610-4846
Practice Address - Fax:224-610-3863
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
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Provider Licenses
StateLicense IDTaxonomies
IL149.0143651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical