Provider Demographics
NPI:1750643250
Name:MUSSELMAN-PALLES, JENNA (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:MUSSELMAN-PALLES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-6546
Mailing Address - Country:US
Mailing Address - Phone:773-235-5705
Mailing Address - Fax:773-235-5747
Practice Address - Street 1:1740 RIDGE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5918
Practice Address - Country:US
Practice Address - Phone:847-475-7003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0147851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical