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General NPI Number Information
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NPI Number | 1366949893
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Entity Type | Organization
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Legal Business Name | JEN MATL DT THATS ME CORP.
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Dates
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Enumeration Date | 04/11/2018
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Last Update Date | 04/11/2018
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Provider Practice Location Address
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Address Line | 3502 SUMAC DR
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City | JOLIET
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State | IL
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Zip | 60435-9018
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Country | US
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Telephone | 708-378-5984
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Fax | 708-286-7028
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Provider Business Mailing Address
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Address Line | 3502 SUMAC DR
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City | JOLIET
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State | IL
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Zip | 60435-9018
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Country | US
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Telephone | 708-378-5984
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Fax | 708-286-7028
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER MARIE MATL
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Credential |
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Telephone | 708-378-5984
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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 |
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License Number State |
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