Provider Demographics
NPI:1538727326
Name:BECKHAM, JENNIFER (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BECKHAM
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 LEAVITT AVE APT 108
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1521
Mailing Address - Country:US
Mailing Address - Phone:708-770-2225
Mailing Address - Fax:
Practice Address - Street 1:1117 LEAVITT AVE APT 108
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-1521
Practice Address - Country:US
Practice Address - Phone:708-770-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL1490233741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health