Healthcare Provider Details

I. General information

NPI: 1083575930
Provider Name (Legal Business Name): JENNIFER BRENNER R/T (R)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11914 S ROUTE 59
PLAINFIELD IL
60585-5110
US

IV. Provider business mailing address

24642 W STEVE RITTOF DR
CHANNAHON IL
60410-9757
US

V. Phone/Fax

Practice location:
  • Phone: 815-733-5952
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number1075706
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: