Provider Demographics
NPI:1790887040
Name:ALTMAN, JEANA (LCPC)
Entity Type:Individual
Prefix:
First Name:JEANA
Middle Name:
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JEANA
Other - Middle Name:
Other - Last Name:CLARKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:1701 E. WOODFIELD ROAD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5113
Mailing Address - Country:US
Mailing Address - Phone:815-356-5050
Mailing Address - Fax:847-240-2418
Practice Address - Street 1:390 E CONGRESS PKWY
Practice Address - Street 2:SUITE J
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6202
Practice Address - Country:US
Practice Address - Phone:815-356-5050
Practice Address - Fax:815-356-5094
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1633897OtherBCBS GROUP NUMBER
IL320078OtherVALUE OPTIONS GRP #
IL320078OtherVALUE OPTIONS GRP #