Provider Demographics
NPI:1457666398
Name:FORD, JENNI (LCPC, ATR-BC, LMHC)
Entity Type:Individual
Prefix:
First Name:JENNI
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:LCPC, ATR-BC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 MAPLE AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-4136
Mailing Address - Country:US
Mailing Address - Phone:630-708-7449
Mailing Address - Fax:
Practice Address - Street 1:1440 MAPLE AVE STE 2B
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-4136
Practice Address - Country:US
Practice Address - Phone:630-708-7449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17736101YM0800X
IL180011269101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health