Provider Demographics
NPI:1588101992
Name:KOLZE, JENNIFER R
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:R
Last Name:KOLZE
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 1:800 S MCHENRY AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7487
Mailing Address - Country:US
Mailing Address - Phone:815-526-3750
Mailing Address - Fax:
Practice Address - Street 1:800 S MCHENRY AVE
Practice Address - Street 2:SUITE F
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7487
Practice Address - Country:US
Practice Address - Phone:815-526-3750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009156103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical