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General NPI Number Information
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NPI Number | 1245401850
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Entity Type | Individual
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Provider Name | JENNIFER J CARRINO B.S.E.D.D.T
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Gender | Female
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Dates
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Enumeration Date | 03/22/2008
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Last Update Date | 03/22/2008
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Provider Practice Location Address
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Address Line | 9344 JEFFERSON AVE
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City | BROOKFIELD
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State | IL
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Zip | 60513-1210
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Country | US
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Telephone | 630-881-8603
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Fax | 708-447-1680
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Provider Business Mailing Address
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Address Line | 9344 JEFFERSON AVE
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City | BROOKFIELD
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State | IL
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Zip | 60513-1210
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Country | US
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Telephone | 630-881-8603
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Fax | 708-447-1680
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number | JCP48800801P
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License Number State | IL
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