Provider Information for 1386645331
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JENNIFER NOONAN LCSW
Other Names:Former Name:JENNIFER SMITH LCSWSex: Female
NPI: 1386645331
Last Updated: 2024-09-24
Certification Date: 2024-09-24
Certification Date: 2024-09-24
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1386645331 | ||||||||||||
| Enumeration Date | 2005-08-02 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 30 W MONROE ST STE 1200 CHICAGO, IL 60603-2420 United States Phone: 312-733-9730 | Fax:773-866-8014 | ||||||||||||
| Primary Practice Address | 4900 BROADWAY GARY, IN 46408-4605 United States Phone: 219-237-5170 | Fax:219-321-1931 | ||||||||||||
| Secondary Practice Address(es) | 4221 ASHEVILLE HWY | ||||||||||||
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