| Doctor Name: | DR. JENNIFER LEE FAST |
| NPI Number: | 1033565833 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | 071008255 |
| Business Practice Address: | 225 E Deerpath Suite 280 Lake Forest, IL - 600451952 |
| Business Phone Number: | 8477966400 |
| Business Fax Number: | |
| Mailing Address: | 18 Campus Cir, LAKE FOREST |
| State: | IL |
| Postal Code: | 600452342 |
| Phone Number: | 7083347508 |
| Fax Number: | |
| NPI Enumeration Date: | 05/11/2016 |
| NPI Last Update Date: | 05/11/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 071008255 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |