Provider Demographics
NPI:1750074183
Name:PERKINS, JANE ELIZABETH (LCPC)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:ELIZABETH
Last Name:PERKINS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:ELIZABETH
Other - Last Name:STEDRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:317 N COTTAGE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61559-9295
Mailing Address - Country:US
Mailing Address - Phone:309-256-9068
Mailing Address - Fax:
Practice Address - Street 1:124 STAGECOACH RD
Practice Address - Street 2:
Practice Address - City:KIRBYVILLE
Practice Address - State:MO
Practice Address - Zip Code:65679-7281
Practice Address - Country:US
Practice Address - Phone:417-448-0144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023020806101YP2500X
IL180.003989101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional