Provider Demographics
NPI:1972989051
Name:COLEMAN, JENNIFER (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 S. MICHIGAN AVE.
Mailing Address - Street 2:STE 121 #5151
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604
Mailing Address - Country:US
Mailing Address - Phone:858-243-6812
Mailing Address - Fax:
Practice Address - Street 1:53 W JACKSON BLVD STE 1626
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3740
Practice Address - Country:US
Practice Address - Phone:858-243-6812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010591103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical