Provider Demographics
NPI:1851836936
Name:LEE, JEANETTE (LSW, JD)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LSW, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 S HAMLIN AVE # 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-2422
Mailing Address - Country:US
Mailing Address - Phone:415-595-0667
Mailing Address - Fax:
Practice Address - Street 1:1835 S HAMLIN AVE # 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-2422
Practice Address - Country:US
Practice Address - Phone:415-595-0667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-29
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.101937104100000X
IL149.0213441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker