Provider Demographics
NPI:1982452512
Name:KING, JENNIFER GAIL (MS, LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GAIL
Last Name:KING
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1948
Mailing Address - Country:US
Mailing Address - Phone:630-587-3777
Mailing Address - Fax:630-587-3777
Practice Address - Street 1:474 BRIARGATE DR
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-2225
Practice Address - Country:US
Practice Address - Phone:630-587-3777
Practice Address - Fax:630-587-3791
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL178-001394101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional