Healthcare Provider Details

I. General information

NPI: 1710789623
Provider Name (Legal Business Name): JENNIFER M BARNEC RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N WINFIELD RD STE 103
WINFIELD IL
60190-1379
US

IV. Provider business mailing address

25 N WINFIELD RD STE 103
WINFIELD IL
60190-1379
US

V. Phone/Fax

Practice location:
  • Phone: 630-938-8266
  • Fax: 630-933-7329
Mailing address:
  • Phone: 630-938-8266
  • Fax: 630-933-7329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164008486
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: