Provider Demographics
NPI:1316810351
Name:TETREAULT, JEANNETTE MARIE
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:MARIE
Last Name:TETREAULT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 BRIARCLIFF LN APT 1
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1592
Mailing Address - Country:US
Mailing Address - Phone:815-348-4501
Mailing Address - Fax:815-401-7672
Practice Address - Street 1:202 N SCHUYLER AVE STE 205
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3601
Practice Address - Country:US
Practice Address - Phone:815-348-4501
Practice Address - Fax:815-401-7672
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.000124101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health