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General NPI Number Information
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NPI Number | 1629643648
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Entity Type | Individual
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Provider Name | JENNIFER ANN MARTIN MSW, LSW
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Gender | Female
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Dates
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Enumeration Date | 05/21/2021
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Last Update Date | 05/21/2021
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Provider Practice Location Address
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Address Line | 5010 FAIRVIEW AVE STE 5
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-5201
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Country | US
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Telephone | 630-869-0149
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Fax |
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Provider Business Mailing Address
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Address Line | 1188 ROYAL GLEN DR APT 119B
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City | GLEN ELLYN
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State | IL
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Zip | 60137-6005
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Country | US
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Telephone | 630-302-8970
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150104615
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License Number State | IL
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