Provider Demographics
NPI:1760624985
Name:VORHEES, JENNIPHER ANN (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIPHER
Middle Name:ANN
Last Name:VORHEES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11493 RIESS RD
Mailing Address - Street 2:
Mailing Address - City:MASCOUTAH
Mailing Address - State:IL
Mailing Address - Zip Code:62258-3741
Mailing Address - Country:US
Mailing Address - Phone:618-789-6029
Mailing Address - Fax:
Practice Address - Street 1:1238 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MASCOUTAH
Practice Address - State:IL
Practice Address - Zip Code:62258-1060
Practice Address - Country:US
Practice Address - Phone:618-789-6029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007581101YP2500X
IL178006047101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional