Provider Demographics
NPI:1831978063
Name:RITER, JENNIFER (LSW, PEL)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:RITER
Suffix:
Gender:F
Credentials:LSW, PEL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 WYNDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6544
Mailing Address - Country:US
Mailing Address - Phone:815-404-4932
Mailing Address - Fax:
Practice Address - Street 1:391 NORTH AVE
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-3204
Practice Address - Country:US
Practice Address - Phone:224-508-6655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.1115291041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool