Provider Demographics
NPI:1689787699
Name:SHEMONIC, JENNIFER NICOLE (BA, LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NICOLE
Last Name:SHEMONIC
Suffix:
Gender:F
Credentials:BA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ELLIS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:62241-1462
Mailing Address - Country:US
Mailing Address - Phone:618-615-2113
Mailing Address - Fax:618-939-4181
Practice Address - Street 1:988 N ILLINOIS ROUTE 3
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-1000
Practice Address - Country:US
Practice Address - Phone:618-939-4444
Practice Address - Fax:618-939-4181
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional