Provider Demographics
NPI:1881318848
Name:DUGAN, JENNIFER J (MA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:DUGAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 S SANGAMON ST
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-2831
Mailing Address - Country:US
Mailing Address - Phone:708-367-2642
Mailing Address - Fax:
Practice Address - Street 1:25425 S WILL CENTER RD
Practice Address - Street 2:
Practice Address - City:MONEE
Practice Address - State:IL
Practice Address - Zip Code:60449-9814
Practice Address - Country:US
Practice Address - Phone:708-367-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1687032103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool