Provider Demographics
NPI:1700422284
Name:JABLONSKI, JENNA (LPC, CADC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:JABLONSKI
Suffix:
Gender:F
Credentials:LPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3335 W DIVERSEY AVE APT 217
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1368
Mailing Address - Country:US
Mailing Address - Phone:616-648-0379
Mailing Address - Fax:
Practice Address - Street 1:1416 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-0939
Practice Address - Country:US
Practice Address - Phone:773-799-8966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36078101YA0400X
IL178.015342101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)