| Doctor Name: | JENNIFER LYNN PELLICANO |
| NPI Number: | 1225426570 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSYD |
| License Number: | 071008942 |
| Business Practice Address: | 1 E County Line Rd Sandwich, IL - 605482178 |
| Business Phone Number: | 8157868606 |
| Business Fax Number: | 8157861541 |
| Mailing Address: | 1120 E Main St, Suite 201 ST CHARLES |
| State: | IL |
| Postal Code: | 601742287 |
| Phone Number: | 6303776613 |
| Fax Number: | 6303776225 |
| NPI Enumeration Date: | 01/08/2015 |
| NPI Last Update Date: | 01/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 071008942 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |