Provider Demographics
NPI:1245521780
Name:KOROTKO, JENIFER CORINNE (LCPC)
Entity type:Individual
Prefix:MRS
First Name:JENIFER
Middle Name:CORINNE
Last Name:KOROTKO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MRS
Other - First Name:JENIFER
Other - Middle Name:CORINNE
Other - Last Name:KOROTKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:3339 W LE MOYNE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-2452
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6778 N NORTHWEST HWY # 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1314
Practice Address - Country:US
Practice Address - Phone:773-683-2781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.006913101YP2500X
IL180008029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional