| Doctor Name: | JENNA FARMER-BRACKETT |
| NPI Number: | 1114350964 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA |
| License Number: | 180008763 |
| Business Practice Address: | 221 E County Rd Jerseyville, IL - 620523190 |
| Business Phone Number: | 6186392010 |
| Business Fax Number: | 6186392015 |
| Mailing Address: | 221 E County Rd, JERSEYVILLE |
| State: | IL |
| Postal Code: | 620523190 |
| Phone Number: | 6186392010 |
| Fax Number: | 6186392015 |
| NPI Enumeration Date: | 08/15/2013 |
| NPI Last Update Date: | 08/15/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 180008763 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |