Individual
DR. RICHARA JENNINGS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
10343 S WESTERN AVE, CHICAGO, IL 60643-2410
(773) 238-2828
(708) 974-3845
Mailing address
9449 S KEDZIE AVE, STE 306, EVERGREEN PARK, IL 60805-2325
(773) 510-0104
(708) 620-8631
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071-007563
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
071-007563
IDFPR
IL
01
—
IL1583002
CMS MEDICARE PTAN
IL
Enumeration date
11/15/2006
Last updated
06/04/2014
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