Provider Demographics
NPI:1881244150
Name:JENNINGS, STEVEN L JR (MA)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:JENNINGS
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 W CHICAGO AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-4377
Mailing Address - Country:US
Mailing Address - Phone:312-625-6604
Mailing Address - Fax:
Practice Address - Street 1:2950 W CHICAGO AVE STE 202
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-4377
Practice Address - Country:US
Practice Address - Phone:312-625-6604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health