Provider Demographics
NPI:1609205996
Name:NOAR, JENNIFER MARIE (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:NOAR
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:6615 N. BIG HOLLOW RD.
Mailing Address - Street 2:THE ANTIOCH GROUP
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61554-2451
Mailing Address - Country:US
Mailing Address - Phone:309-692-6622
Mailing Address - Fax:309-692-6952
Practice Address - Street 1:2011 N KNOXVILLE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-2414
Practice Address - Country:US
Practice Address - Phone:309-687-7774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.009373101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health