Provider Demographics
NPI:1841530268
Name:BACANI, JENNIFER JOY
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:JOY
Last Name:BACANI
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 1:2650 W BELDEN AVE
Mailing Address - Street 2:APT 111
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3039
Mailing Address - Country:US
Mailing Address - Phone:248-514-4870
Mailing Address - Fax:
Practice Address - Street 1:2650 W BELDEN AVE
Practice Address - Street 2:APT 111
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3039
Practice Address - Country:US
Practice Address - Phone:248-514-4870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor