Provider Demographics
NPI:1295321677
Name:JENNIFER DAVIS AND MICHELLE S. WHITE
Entity type:Organization
Organization Name:JENNIFER DAVIS AND MICHELLE S. WHITE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:N
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-282-2322
Mailing Address - Street 1:4801 W PETERSON AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5730
Mailing Address - Country:US
Mailing Address - Phone:773-282-2322
Mailing Address - Fax:773-282-2853
Practice Address - Street 1:4801 W PETERSON AVE STE 401
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5730
Practice Address - Country:US
Practice Address - Phone:773-282-2322
Practice Address - Fax:773-282-2853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-18
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty