Provider Demographics
NPI:1881603637
Name:PFAFF, JENNIFER A (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:PFAFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:HENK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:960 RAND RD
Mailing Address - Street 2:215
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2352
Mailing Address - Country:US
Mailing Address - Phone:847-699-2100
Mailing Address - Fax:
Practice Address - Street 1:960 RAND RD
Practice Address - Street 2:215
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-2352
Practice Address - Country:US
Practice Address - Phone:847-699-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490148671041C0700X
IN34005237A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000618201OtherANTHEM
IN100270530AMedicaid
IN100270530AMedicaid
IN150074Medicare PIN
IN264430YYMedicare PIN