Healthcare Provider Details

I. General information

NPI: 1649213703
Provider Name (Legal Business Name): MS. JENNIFER BARRETT-ZITKUS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 BLUE HERON COURT
ROUND LAKE IL
60073
US

IV. Provider business mailing address

139 BLUE HERON COURT
ROUND LAKE IL
60073
US

V. Phone/Fax

Practice location:
  • Phone: 847-546-1557
  • Fax: 847-546-1558
Mailing address:
  • Phone: 847-546-1557
  • Fax: 847-546-1558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License NumberJB85470899P
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: