Provider Demographics
NPI:1841901675
Name:JENNIFER MORALES PSYD PLLC
Entity type:Organization
Organization Name:JENNIFER MORALES PSYD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-220-4602
Mailing Address - Street 1:6787 N JEAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-1352
Mailing Address - Country:US
Mailing Address - Phone:847-220-4602
Mailing Address - Fax:773-496-7155
Practice Address - Street 1:5 REVERE DR STE 200
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-8000
Practice Address - Country:US
Practice Address - Phone:847-220-4602
Practice Address - Fax:773-496-7155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty