Healthcare Provider Details

I. General information

NPI: 1528030178
Provider Name (Legal Business Name): JENNIFER CHIARAMONTE ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 WILLOWCREEK CT
CLARENDON HILLS IL
60514-1691
US

IV. Provider business mailing address

517 WILLOWCREEK CT
CLARENDON HILLS IL
60514-1691
US

V. Phone/Fax

Practice location:
  • Phone: 630-794-9087
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: