Healthcare Provider Details

I. General information

NPI: 1639527997
Provider Name (Legal Business Name): JENNIFER DIAMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 N. HIGHLAND AVENUA
AURORA IL
60506
US

IV. Provider business mailing address

1043 SARATOGA ROAD
NAPERVILLE IL
60564
US

V. Phone/Fax

Practice location:
  • Phone: 630-966-4430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: