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NPI Code Detail

MEDICARE: JENNIFER DEQUATTRO

MEDICARE:   JENNIFER  DEQUATTRO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor180009563IL

General Provider Information

NPI Number : 1255711420
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER DEQUATTRO
Provider Business Mailing Address
First Line : 430 N WILKE RD APT 206
Second Line :
City : PALATINE
State : IL
Zip : 60074-4157
Country : US
Telephone Number : 312-905-4878
Fax Number :
Provider Business Practice Location Address
First Line : 121 S WILKE RD STE 500
Second Line :
City : ARLINGTON HEIGHTS
State : IL
Zip : 60005-1528
Country : US
Telephone Number : 847-253-9769
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2015
Last Update Date : 06/03/2015

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Directions to “ JENNIFER DEQUATTRO ” Practice Location

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