Provider Demographics
NPI:1326661885
Name:GOSS, JENNIFER T (LCPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:T
Last Name:GOSS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:GOSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:200 INWOOD DR APT 110
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-6710
Mailing Address - Country:US
Mailing Address - Phone:847-401-9618
Mailing Address - Fax:
Practice Address - Street 1:405 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-3104
Practice Address - Country:US
Practice Address - Phone:847-566-0164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178008121101YM0800X
IL180.013030101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health