Provider Demographics
NPI:1508195736
Name:GALLE, JENNIFER LYNN (MA, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:GALLE
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18530 W 3000N RD LOT 59
Mailing Address - Street 2:
Mailing Address - City:REDDICK
Mailing Address - State:IL
Mailing Address - Zip Code:60961-5918
Mailing Address - Country:US
Mailing Address - Phone:815-212-0082
Mailing Address - Fax:
Practice Address - Street 1:15010 S RAVINIA AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3162
Practice Address - Country:US
Practice Address - Phone:708-364-0580
Practice Address - Fax:708-364-0480
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007070101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor