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General NPI Number Information
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NPI Number | 1255299806
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Entity Type | Individual
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Provider Name | JENNIFER REBECCA MASSARELLI M.ED
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Gender | Female
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Dates
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Enumeration Date | 01/13/2026
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 1740 WAUKEGAN RD # 209
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City | GLENVIEW
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State | IL
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Zip | 60025-2157
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Country | US
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Telephone | 847-309-5366
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Fax |
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Provider Business Mailing Address
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Address Line | 801 NORMANDY LN
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City | GLENVIEW
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State | IL
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Zip | 60025-3209
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Country | US
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Telephone | 847-309-5366
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Fax |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | IEIN174836
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License Number State | IL
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