Provider Demographics
NPI:1518341379
Name:THOMPSON, JENAE (LCPC)
Entity Type:Individual
Prefix:
First Name:JENAE
Middle Name:
Last Name:THOMPSON
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 1:332 S. MICHIGAN AVENUE #5847
Mailing Address - Street 2:SUITE 121
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-4302
Mailing Address - Country:US
Mailing Address - Phone:708-801-8735
Mailing Address - Fax:855-703-0001
Practice Address - Street 1:332 S. MICHIGAN AVENUE #5847
Practice Address - Street 2:SUITE 121
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-4302
Practice Address - Country:US
Practice Address - Phone:708-801-8735
Practice Address - Fax:855-703-0001
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-11
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006221101YP2500X
IL180.013308101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1518341379Medicaid