Healthcare Provider Details

I. General information

NPI: 1346810496
Provider Name (Legal Business Name): JENNIFER BUENO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S MILWAUKEE AVE STE 235
WHEELING IL
60090-5098
US

IV. Provider business mailing address

1529 SOUTHPORT CT
ZION IL
60099-4730
US

V. Phone/Fax

Practice location:
  • Phone: 847-465-9556
  • Fax: 847-465-9621
Mailing address:
  • Phone: 224-627-8446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: