Provider Demographics
NPI:1720010622
Name:PHILIPSON, JENNY K (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:K
Last Name:PHILIPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:JENNY
Other - Middle Name:P
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LCSW
Mailing Address - Street 1:606 SHERIDAN ROAD 1 W
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202
Mailing Address - Country:US
Mailing Address - Phone:847-644-2462
Mailing Address - Fax:847-328-3703
Practice Address - Street 1:636 CHURCH ST SUITE 601
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:847-644-2462
Practice Address - Fax:847-328-3703
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490091401041C0700X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212756Medicare ID - Type Unspecified