Provider Demographics
NPI:1700933074
Name:BATES, JENNIFER J (LCPC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:J
Last Name:BATES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 E CHESTNUT ST STE C
Mailing Address - Street 2:P.O. BOX 792
Mailing Address - City:CANTON
Mailing Address - State:IL
Mailing Address - Zip Code:61520-2769
Mailing Address - Country:US
Mailing Address - Phone:309-649-1660
Mailing Address - Fax:309-649-1660
Practice Address - Street 1:162 E CHESTNUT ST
Practice Address - Street 2:SUITE C
Practice Address - City:CANTON
Practice Address - State:IL
Practice Address - Zip Code:61520-2769
Practice Address - Country:US
Practice Address - Phone:309-649-1660
Practice Address - Fax:309-649-1660
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-003260101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health