Provider Demographics
NPI:1427253194
Name:WHITESIDES, JENNIFER LILIANI (MSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LILIANI
Last Name:WHITESIDES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1597 S MOORLAND RD
Mailing Address - Street 2:#104
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-1583
Mailing Address - Country:US
Mailing Address - Phone:407-301-9031
Mailing Address - Fax:
Practice Address - Street 1:45 S PARK BLVD
Practice Address - Street 2:STE 255
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6280
Practice Address - Country:US
Practice Address - Phone:630-942-8803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker