Provider Demographics
NPI:1447485800
Name:STELTER, JENNIFER R (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:R
Last Name:STELTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:R
Other - Last Name:JOURDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1462 FARGO BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2979
Mailing Address - Country:US
Mailing Address - Phone:224-242-0672
Mailing Address - Fax:
Practice Address - Street 1:1462 FARGO BOULEVARD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2979
Practice Address - Country:US
Practice Address - Phone:224-242-0672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007679103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical