Provider Demographics
NPI:1093203093
Name:SKINNER, DENISE L (LCPC)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:L
Last Name:SKINNER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E JACKSON BLVD STE 1500
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-4184
Mailing Address - Country:US
Mailing Address - Phone:877-381-6538
Mailing Address - Fax:
Practice Address - Street 1:1300 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-3112
Practice Address - Country:US
Practice Address - Phone:877-381-6538
Practice Address - Fax:217-245-7282
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.004044101YP2500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional