Provider Demographics
NPI:1255180303
Name:JENNINGS, STEPHEN NATHANIEL (MA)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:NATHANIEL
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 COLLEGE AVE APT 16
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4351
Mailing Address - Country:US
Mailing Address - Phone:559-321-5567
Mailing Address - Fax:
Practice Address - Street 1:1147 W OHIO ST FL 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-6472
Practice Address - Country:US
Practice Address - Phone:312-772-9796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health