| Doctor Name: | JENNIFER BOOTHE BROBST |
| NPI Number: | 1104064443 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | 071007544 |
| Business Practice Address: | 18w100 22nd St Suite 130 Oakbrook Terrace, IL - 601814499 |
| Business Phone Number: | 6304249204 |
| Business Fax Number: | 6304249208 |
| Mailing Address: | Po Box 387, ADDISON |
| State: | IL |
| Postal Code: | 601010387 |
| Phone Number: | 6304958702 |
| Fax Number: | 6304958703 |
| NPI Enumeration Date: | 01/24/2009 |
| NPI Last Update Date: | 01/24/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 071007544 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |