Provider Demographics
NPI:1558596833
Name:BOVEE, JENNIFER R (LCSW, CRADC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:R
Last Name:BOVEE
Suffix:
Gender:F
Credentials:LCSW, CRADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 5232
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61702
Mailing Address - Country:US
Mailing Address - Phone:309-445-0394
Mailing Address - Fax:309-417-3550
Practice Address - Street 1:205 N WILLIAMSBURG DR STE A
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-7721
Practice Address - Country:US
Practice Address - Phone:309-807-5077
Practice Address - Fax:309-214-9679
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149012901101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health