Provider Demographics
NPI:1396998225
Name:HULTGREN, JENNA M
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:M
Last Name:HULTGREN
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 1:4708 FAIR ELMS AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1707
Mailing Address - Country:US
Mailing Address - Phone:219-798-4767
Mailing Address - Fax:
Practice Address - Street 1:4708 FAIR ELMS AVE
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1707
Practice Address - Country:US
Practice Address - Phone:219-798-4767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional