Provider Demographics
NPI:1265138838
Name:RAYMOND, JENNIFER LYN (LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYN
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8023 HARRIER AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-7050
Mailing Address - Country:US
Mailing Address - Phone:815-523-6603
Mailing Address - Fax:
Practice Address - Street 1:500 BROWN BLVD
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2328
Practice Address - Country:US
Practice Address - Phone:815-214-9766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178018869101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional