Provider Demographics
NPI:1558669549
Name:LOSCH, JENNA CATHERINE
Entity Type:Individual
Prefix:MISS
First Name:JENNA
Middle Name:CATHERINE
Last Name:LOSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 CHERRY LN
Mailing Address - Street 2:APT. 310
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1173
Mailing Address - Country:US
Mailing Address - Phone:630-404-4210
Mailing Address - Fax:
Practice Address - Street 1:3100 DUNDEE RD
Practice Address - Street 2:SUITE 704
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2437
Practice Address - Country:US
Practice Address - Phone:847-498-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst