Provider Demographics
NPI:1679316186
Name:JENKINS, MOLLY FOXWORTH (LCSW)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:FOXWORTH
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 W BELLE PLAINE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-7203
Mailing Address - Country:US
Mailing Address - Phone:773-620-5724
Mailing Address - Fax:
Practice Address - Street 1:1524 W BELLE PLAINE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-7203
Practice Address - Country:US
Practice Address - Phone:773-620-5724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490215981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical