Provider Demographics
NPI:1902445059
Name:INIQUEZ, JENNIFER REBECCA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:REBECCA
Last Name:INIQUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:REBECCA
Other - Last Name:BLANKENSHIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4322 KENILWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:STICKNEY
Mailing Address - State:IL
Mailing Address - Zip Code:60402-4349
Mailing Address - Country:US
Mailing Address - Phone:708-296-3763
Mailing Address - Fax:
Practice Address - Street 1:3801 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-4398
Practice Address - Country:US
Practice Address - Phone:708-656-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0213791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical