Provider Demographics
NPI:1922232487
Name:MCCOMB, JENNIFER L (MSC, LMFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:MCCOMB
Suffix:
Gender:F
Credentials:MSC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 JUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-1316
Mailing Address - Country:US
Mailing Address - Phone:312-208-9112
Mailing Address - Fax:
Practice Address - Street 1:1830 SHERMAN AVE STE 205
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3771
Practice Address - Country:US
Practice Address - Phone:847-840-9575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000717106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist