Provider Demographics
NPI:1518226497
Name:PAGONE, JENNIFER J (LCPC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:J
Last Name:PAGONE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 N IL ROUTE 23
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:IL
Mailing Address - Zip Code:60152-9692
Mailing Address - Country:US
Mailing Address - Phone:773-339-7949
Mailing Address - Fax:847-660-7997
Practice Address - Street 1:1403 N IL ROUTE 23
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:IL
Practice Address - Zip Code:60152-9692
Practice Address - Country:US
Practice Address - Phone:773-339-7949
Practice Address - Fax:847-660-7997
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008212101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional