Provider Demographics
NPI:1457659609
Name:BALDWIN, JENNIFER L (LCPC, PHD)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:LCPC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 S. KIMBARK AVE #3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637
Mailing Address - Country:US
Mailing Address - Phone:770-312-4637
Mailing Address - Fax:
Practice Address - Street 1:6104 S. WOODLAWN AVE
Practice Address - Street 2:#410
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637
Practice Address - Country:US
Practice Address - Phone:773-752-1945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.07112101Y00000X
IL180.008427101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor