Provider Demographics
NPI:1689024853
Name:TROTTER, JEANETTE M (LCPC, NCC)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:M
Last Name:TROTTER
Suffix:
Gender:F
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:M
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 W MASON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:POLO
Mailing Address - State:IL
Mailing Address - Zip Code:61064-1501
Mailing Address - Country:US
Mailing Address - Phone:815-973-5982
Mailing Address - Fax:815-946-2592
Practice Address - Street 1:115 W MASON ST STE 201
Practice Address - Street 2:
Practice Address - City:POLO
Practice Address - State:IL
Practice Address - Zip Code:61064-1501
Practice Address - Country:US
Practice Address - Phone:815-973-5982
Practice Address - Fax:815-946-2592
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007503101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional