Provider Demographics
NPI:1194269837
Name:WEINTROB, JENNA (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
Last Name:WEINTROB
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:25 E WASHINGTON ST STE 1708
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1838
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 E WASHINGTON ST STE 1708
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1838
Practice Address - Country:US
Practice Address - Phone:773-987-6763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6083103TC0700X
IL071.009758103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical