MEDICARE: JACQUELINE TOLENTINO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1184166605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE TOLENTINO

Provider Business Mailing Address
First Line	:	4557 N NARRAGANSETT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-3029
Country	:	US
Telephone Number	:	773-629-3323
Fax Number	:

Provider Business Practice Location Address
First Line	:	4412 N OAK PARK AVE
Second Line	:
City	:	HARWOOD HEIGHTS
State	:	IL
Zip	:	60706-4836
Country	:	US
Telephone Number	:	773-793-4846
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2016
Last Update Date	:	11/15/2016

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Directions to “ JACQUELINE TOLENTINO ” Practice Location

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