Healthcare Provider Details

I. General information

NPI: 1952788986
Provider Name (Legal Business Name): JENNIFER HARTMANN L.AC., LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CHICAGO AVE SUITE 100
EVANSTON IL
60202-1872
US

IV. Provider business mailing address

469 S PARK RD
LOMBARD IL
60148-2540
US

V. Phone/Fax

Practice location:
  • Phone: 630-519-6514
  • Fax:
Mailing address:
  • Phone: 630-935-5450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198.001339
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number227.016997
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: