JENNIFER D FORMAN Social Worker License verification

Business Entity

NOT RENEWED

License Type

Social Worker

Description

LICENSED CLINICAL SOCIAL WORKER

License Number

149005314

License Status

NOT RENEWED

Business

First Name

JENNIFER D

Last Name

FORMAN

Business Name

JENNIFER D FORMAN

Original Issue Date

03/08/1993

Expiration Date

11/30/1993

City

EVANSTON

State

Zip

60202

County

COOK

Ever Disciplined

LastModifiedDate

09/02/2005