Provider Demographics
NPI:1902205842
Name:MANTIS, JENNY (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:MANTIS
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 1:25 E SCHAUMBURG RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3550
Mailing Address - Country:US
Mailing Address - Phone:847-981-3514
Mailing Address - Fax:847-230-3787
Practice Address - Street 1:25 E SCHAUMBURG RD
Practice Address - Street 2:SUITE 106
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-3550
Practice Address - Country:US
Practice Address - Phone:847-981-3514
Practice Address - Fax:847-230-3787
Is Sole Proprietor?:No
Enumeration Date:2014-08-16
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0162321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical