Provider Demographics
NPI:1427615301
Name:MARTIN, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 W EVERGREEN CT
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-6769
Mailing Address - Country:US
Mailing Address - Phone:847-772-7709
Mailing Address - Fax:
Practice Address - Street 1:1345 WILEY RD STE 124
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4356
Practice Address - Country:US
Practice Address - Phone:847-772-7709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-25
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional