Provider Demographics
NPI:1972378032
Name:BRINKMAN, JENNIFER TAYLOR (LSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TAYLOR
Last Name:BRINKMAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7410 PINGREE RD
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-8030
Mailing Address - Country:US
Mailing Address - Phone:630-935-7421
Mailing Address - Fax:
Practice Address - Street 1:5400 W ELM ST
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4010
Practice Address - Country:US
Practice Address - Phone:815-322-1160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.1115861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical