1619095437 NPI number — JENNIFER R JONES OTR/L, CHT

Table of content: JENNIFER R JONES OTR/L, CHT (NPI 1619095437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619095437 NPI number — JENNIFER R JONES OTR/L, CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
JENNIFER
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L, CHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FAHEY
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619095437
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 OAKMONT LN
Provider Second Line Business Mailing Address:
STE 600C
Provider Business Mailing Address City Name:
WESTMONT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60559-5548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-575-1980
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5300 N. ILLINOIS
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
FAIRVIEW HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-624-9300
Provider Business Practice Location Address Fax Number:
618-624-9330
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  056-006388 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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