Provider Demographics
NPI:1639617509
Name:BUCKLER, JENNIFER (LCPC, ATR)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BUCKLER
Suffix:
Gender:F
Credentials:LCPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 N HONORE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1308
Mailing Address - Country:US
Mailing Address - Phone:937-554-3064
Mailing Address - Fax:
Practice Address - Street 1:4336 SARATOGA AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2866
Practice Address - Country:US
Practice Address - Phone:847-477-8244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-10
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010189101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional