1457520785 NPI number — JENNIFER LEE FERGUSON CADC, LSW

Table of content: JENNIFER LEE FERGUSON CADC, LSW (NPI 1457520785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457520785 NPI number — JENNIFER LEE FERGUSON CADC, LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERGUSON
Provider First Name:
JENNIFER
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CADC, LSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RICHARDSON
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457520785
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1122 SOUTH 4TH STREET
Provider Second Line Business Mailing Address:
PAWPRINT PATHWAY COUNSELING, PLLC
Provider Business Mailing Address City Name:
MONMOUTH
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-734-2813
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1122 S 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONMOUTH
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61462-2734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-734-2813
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  26742 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 34961 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 007831 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 149.017885 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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