| Doctor Name: | JENNIFER CALLISS |
| NPI Number: | 1164439584 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.C.P.C. |
| License Number: | |
| Business Practice Address: | 21 N Skokie Hwy Suite 203 Lake Bluff, IL - 600441777 |
| Business Phone Number: | 8478001167 |
| Business Fax Number: | 8472956176 |
| Mailing Address: | 21 N Skokie Hwy, Suite 203 LAKE BLUFF |
| State: | IL |
| Postal Code: | 600441777 |
| Phone Number: | 8478001167 |
| Fax Number: | 8472956176 |
| NPI Enumeration Date: | 08/01/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |