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General NPI Number Information
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NPI Number | 1891687182
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Entity Type | Individual
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Provider Name | JAZMIN QUINTANILLA-RENDON
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Gender | Female
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Dates
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Enumeration Date | 07/19/2025
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Last Update Date | 07/19/2025
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Provider Practice Location Address
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Address Line | 2410 SAMPSON ST
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City | GREAT LAKES
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State | IL
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Zip | 60088-2942
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Country | US
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Telephone | 847-688-2469
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Fax |
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Provider Business Mailing Address
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Address Line | 12772 71ST ST APT 319
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City | KENOSHA
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State | WI
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Zip | 53142-8431
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Country | US
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Telephone | 619-712-7944
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 121704
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License Number State | CA
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