Active NPI
Jennifer Alice Boender, LPC
- Professional Counselor
- Oak Forest, IL
National Provider Identifier
1023345733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 178006381
- Practice address
- 15601 Cicero Ave
Suite 103
Oak Forest, IL 60452-3635 - Phone
- (708) 687-3479
- NPI assigned
- Nov 17, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178006381 | IL | Primary |
Addresses
Primary practice location
15601 Cicero Ave
Suite 103
Oak Forest, IL 60452-3635
Mailing address
15601 Cicero Ave
Suite 103
Oak Forest, IL 60452-3635
Phone (708) 687-3479
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178006381 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Olive Branch Counseling Associates, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Counselor
- Oak Forest, IL
- NPI 1730124157
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1258416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258416000000",
"number": "1023345733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15601 CICERO AVE",
"address_2": "SUITE 103",
"city": "OAK FOREST",
"state": "IL",
"postal_code": "604523635",
"telephone_number": "708-687-3479"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15601 CICERO AVE",
"address_2": "SUITE 103",
"city": "OAK FOREST",
"state": "IL",
"postal_code": "604523635",
"telephone_number": "708-687-3479"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOENDER",
"first_name": "JENNIFER",
"middle_name": "ALICE",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-11-17",
"last_updated": "2009-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178006381",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oak Forest, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.