Provider Demographics
NPI:1912206269
Name:ART OF REFLECTION PC
Entity Type:Organization
Organization Name:ART OF REFLECTION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLECKNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-965-0588
Mailing Address - Street 1:240 E LAKE ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-2890
Mailing Address - Country:US
Mailing Address - Phone:312-965-0588
Mailing Address - Fax:
Practice Address - Street 1:501 W STATE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2149
Practice Address - Country:US
Practice Address - Phone:312-965-0588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.011783251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health