Healthcare Provider Details

I. General information

NPI: 1437655073
Provider Name (Legal Business Name): JENNIFER HULS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1752 WINDSOR RD STE 202
LOVES PARK IL
61111-4276
US

IV. Provider business mailing address

1752 WINDSOR RD STE 202
LOVES PARK IL
61111-4276
US

V. Phone/Fax

Practice location:
  • Phone: 815-977-3747
  • Fax: 779-774-3282
Mailing address:
  • Phone: 815-977-3747
  • Fax: 779-774-3282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227.020404
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: