Provider Demographics
NPI:1598062994
Name:MARDER, JENNY ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:ELIZABETH
Last Name:MARDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:ELIZABETH
Other - Last Name:MARDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1800 S BUHR MILL CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-6467
Mailing Address - Country:US
Mailing Address - Phone:217-741-7665
Mailing Address - Fax:
Practice Address - Street 1:1800 S BUHR MILL CT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6467
Practice Address - Country:US
Practice Address - Phone:217-741-7665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-21
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor