Healthcare Provider Details

I. General information

NPI: 1043466840
Provider Name (Legal Business Name): JENNIFER BARRUFFI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 DEER RUN RD
LAKEMOOR IL
60051-8624
US

IV. Provider business mailing address

524 DEER RUN RD
LAKEMOOR IL
60051-8624
US

V. Phone/Fax

Practice location:
  • Phone: 815-578-0081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number057.001826
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: