| Doctor Name: | JENNIFER KRISTYN SANSONE |
| NPI Number: | 1023454709 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSYD |
| License Number: | 071008595 |
| Business Practice Address: | 27w130 Roosevelt Rd Suite 203 Winfield, IL - 601901611 |
| Business Phone Number: | 6305888490 |
| Business Fax Number: | 6305888491 |
| Mailing Address: | 27w130 Roosevelt Rd, Suite 203 WINFIELD |
| State: | IL |
| Postal Code: | 601901611 |
| Phone Number: | 6305888490 |
| Fax Number: | 6305888491 |
| NPI Enumeration Date: | 05/21/2013 |
| NPI Last Update Date: | 12/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 071008595 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |