Provider Demographics
NPI:1255524104
Name:BAUER, JENNA LAUREN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:LAUREN
Last Name:BAUER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 W NORTH AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-8274
Mailing Address - Country:US
Mailing Address - Phone:872-208-8833
Mailing Address - Fax:
Practice Address - Street 1:1200 W HARRISON ST
Practice Address - Street 2:2010 SSB, UIC COUNSELING CENTER (MC333)
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3320
Practice Address - Country:US
Practice Address - Phone:312-996-3490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X
IL071.008558103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health