Provider Demographics
NPI:1770720088
Name:STREETS, JENNIFER L (LCPC, LMHC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:STREETS
Suffix:
Gender:F
Credentials:LCPC, LMHC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:STREETS WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC, LMHC
Mailing Address - Street 1:630 HILLANDALE DR
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:IL
Mailing Address - Zip Code:61270-2017
Mailing Address - Country:US
Mailing Address - Phone:309-507-1791
Mailing Address - Fax:
Practice Address - Street 1:215 6TH AVE S STE 25
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-4347
Practice Address - Country:US
Practice Address - Phone:563-242-9210
Practice Address - Fax:563-243-0730
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007076101YP2500X
IA001200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional