Provider Demographics
NPI:1851865539
Name:RIECK, JENNIFER MARTIN (LCPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARTIN
Last Name:RIECK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:NEWTON
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1117 S MILWAUKEE AVE STE A12
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5268
Mailing Address - Country:US
Mailing Address - Phone:224-277-6445
Mailing Address - Fax:
Practice Address - Street 1:1117 S MILWAUKEE AVE STE A12
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5268
Practice Address - Country:US
Practice Address - Phone:224-277-6445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.015243101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional