Provider Demographics
NPI:1760814677
Name:BATZA, JENNIFER (LCSW, AM)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BATZA
Suffix:
Gender:F
Credentials:LCSW, AM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 CHURCH ST STE 258
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3840
Mailing Address - Country:US
Mailing Address - Phone:312-375-9453
Mailing Address - Fax:312-577-0448
Practice Address - Street 1:708 CHURCH ST STE 258
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3840
Practice Address - Country:US
Practice Address - Phone:312-375-4953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490144291041C0700X
IL149-0144291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical