Provider Demographics
NPI:1902418486
Name:CHICOINE, JENNIFER ELIZABETH (MA, LCPC, CCTP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:CHICOINE
Suffix:
Gender:F
Credentials:MA, LCPC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15010 S RAVINIA AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-5353
Mailing Address - Country:US
Mailing Address - Phone:708-971-0470
Mailing Address - Fax:708-590-6573
Practice Address - Street 1:15010 S RAVINIA AVE STE 12
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-5353
Practice Address - Country:US
Practice Address - Phone:708-971-0470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.014898OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION