Provider Demographics
NPI:1932339850
Name:JENNIFER L. MCCOMB INC.
Entity type:Organization
Organization Name:JENNIFER L. MCCOMB INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:312-208-9112
Mailing Address - Street 1:936 HINMAN AVE
Mailing Address - Street 2:3S
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-4511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2550 CRAWFORD AVE
Practice Address - Street 2:22
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4900
Practice Address - Country:US
Practice Address - Phone:312-208-9112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000717106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty