Provider Demographics
NPI:1437683158
Name:PFEIFER, JACQUELYN (LMFT)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:PFEIFER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 W OHIO ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-1517
Mailing Address - Country:US
Mailing Address - Phone:312-687-5431
Mailing Address - Fax:
Practice Address - Street 1:2117 W OHIO ST APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-1517
Practice Address - Country:US
Practice Address - Phone:312-687-5431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166001266106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist