Provider Demographics
NPI:1245861202
Name:SMITH, JENNIFER DEBORAE (LCPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DEBORAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23654 SPRINGS CT UNIT 115
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-2243
Mailing Address - Country:US
Mailing Address - Phone:815-302-6941
Mailing Address - Fax:
Practice Address - Street 1:9641 W 153RD ST STE 48
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3777
Practice Address - Country:US
Practice Address - Phone:708-963-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2023-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.015343101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional