Provider Demographics
NPI:1477733905
Name:GODLOVE, JENNIFER A (MA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:GODLOVE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17414 FOX BEND LN
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-4653
Mailing Address - Country:US
Mailing Address - Phone:312-502-0594
Mailing Address - Fax:
Practice Address - Street 1:17414 FOX BEND LN
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-4653
Practice Address - Country:US
Practice Address - Phone:312-502-0594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103T00000XBehavioral Health & Social Service ProvidersPsychologist