1720010622 NPI number — MS. JENNY K PHILIPSON LCSW

Table of content: MS. JENNY K PHILIPSON LCSW (NPI 1720010622)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720010622 NPI number — MS. JENNY K PHILIPSON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILIPSON
Provider First Name:
JENNY
Provider Middle Name:
K
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEWIS
Provider Other First Name:
JENNY
Provider Other Middle Name:
P
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A., L.C.S.W.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720010622
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
606 SHERIDAN ROAD 1 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-644-2462
Provider Business Mailing Address Fax Number:
847-328-3703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
636 CHURCH ST SUITE 601
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVANSTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-644-2462
Provider Business Practice Location Address Fax Number:
847-328-3703
Provider Enumeration Date:
07/07/2006

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: 1041C0700X , with the licence number:  149009140 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X , with the licence number: 149009140 , 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)