Provider Demographics
NPI:1326440454
Name:JENNIFER C. PANNING PSYD PC
Entity Type:Organization
Organization Name:JENNIFER C. PANNING PSYD PC
Other - Org Name:MINDFUL PSYCHOLOGY ASSOCIATES PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:C
Authorized Official - Last Name:PANNING
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-864-0600
Mailing Address - Street 1:636 CHURCH ST STE 520
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4581
Mailing Address - Country:US
Mailing Address - Phone:847-864-0600
Mailing Address - Fax:847-859-6996
Practice Address - Street 1:636 CHURCH ST.
Practice Address - Street 2:STE. 510
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4508
Practice Address - Country:US
Practice Address - Phone:847-864-0600
Practice Address - Fax:847-859-6996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71-006778103T00000X
103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty