Provider Demographics
NPI:1770053738
Name:O'HARE, JENNIFER ELISE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELISE
Last Name:O'HARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13400 S ROUTE 59 UNIT 116
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-5830
Mailing Address - Country:US
Mailing Address - Phone:815-254-7400
Mailing Address - Fax:815-254-7408
Practice Address - Street 1:24821 W 135TH ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-5413
Practice Address - Country:US
Practice Address - Phone:815-254-7400
Practice Address - Fax:815-254-7408
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178010716101YP2500X
IL180011869101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional