Provider Demographics
NPI:1316547326
Name:GOSNELL, JENNIFER K (LCPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:GOSNELL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 OAKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60051-2556
Mailing Address - Country:US
Mailing Address - Phone:815-823-4859
Mailing Address - Fax:
Practice Address - Street 1:4209 W SHAMROCK LN UNIT C
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8700
Practice Address - Country:US
Practice Address - Phone:224-509-8026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178016341101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional