Provider Demographics
NPI:1396924148
Name:MALONE, JEANNE LYN (LCPC)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:LYN
Last Name:MALONE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2314
Mailing Address - Country:US
Mailing Address - Phone:217-744-3525
Mailing Address - Fax:217-744-3535
Practice Address - Street 1:408 SOUTH FIFTH STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62701
Practice Address - Country:US
Practice Address - Phone:217-528-1988
Practice Address - Fax:217-528-1989
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-005021101YP2500X
IL10180-005021101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional