Provider Demographics
NPI:1255925434
Name:KLINGENBERG, JENNEA AILEEN (PSYD)
Entity type:Individual
Prefix:
First Name:JENNEA
Middle Name:AILEEN
Last Name:KLINGENBERG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JENNEA
Other - Middle Name:AILEEN
Other - Last Name:BIVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1709 TRAILS DR
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-7826
Mailing Address - Country:US
Mailing Address - Phone:773-842-9520
Mailing Address - Fax:
Practice Address - Street 1:1709 TRAILS DR
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-7826
Practice Address - Country:US
Practice Address - Phone:773-842-9520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-27
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional