Provider Demographics
NPI:1801275771
Name:MARSH, JENNIFER LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:MARSH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 LAKE COOK RD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5646
Mailing Address - Country:US
Mailing Address - Phone:847-405-0220
Mailing Address - Fax:
Practice Address - Street 1:420 LAKE COOK RD
Practice Address - Street 2:SUITE 113
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5646
Practice Address - Country:US
Practice Address - Phone:847-405-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0173491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical