Provider Information for 1497435168
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JENNIFER G BROOKS LCPC
Other Names:Professional Name:JENNI BROOKS LCPCSex: Female
NPI: 1497435168
Last Updated: 2023-07-18
Certification Date: 2023-07-18
Certification Date: 2023-07-18
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1497435168 | ||||||||
| Enumeration Date | 2023-07-18 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 422 S HILLSDALE AVE PEORIA, IL 61604-5810 United States Phone: 309-253-6778 | Fax: | ||||||||
| Primary Practice Address | 221 NE GLEN OAK AVE PEORIA, IL 61636-0001 United States Phone: 309-672-4651 | Fax: | ||||||||
| Secondary Practice Address(es) | 341 BUENA VISTA AVE | ||||||||
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