Individual
JENNIFER LYNNE FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
5235 N CLARK ST, STE 2N, CHICAGO, IL 60640-2122
(773) 310-1583
Mailing address
2934 N CLARK ST, #3E, CHICAGO, IL 60657-5230
(773) 310-1583
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180.007122
IL
Other
Enumeration date
02/17/2009
Last updated
02/17/2009
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