Provider Demographics
NPI:1912167636
Name:MANFRE, JENNIFER E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:E
Last Name:MANFRE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1284
Mailing Address - Country:US
Mailing Address - Phone:630-968-0792
Mailing Address - Fax:630-477-0201
Practice Address - Street 1:6440 MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1284
Practice Address - Country:US
Practice Address - Phone:630-968-0792
Practice Address - Fax:630-477-0201
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007476103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical