Provider Demographics
NPI:1972547388
Name:HAMILTON, JENNIFER LYNN (MS LCPC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNN
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MS LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 KREITZER AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-5637
Mailing Address - Country:US
Mailing Address - Phone:309-830-4553
Mailing Address - Fax:
Practice Address - Street 1:112 BOEYKENS PL
Practice Address - Street 2:SUITE 4A
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-2152
Practice Address - Country:US
Practice Address - Phone:309-830-4553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-003930101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04932460OtherBC/BS