Provider Demographics
NPI:1104379825
Name:HERNANDEZ, JENNY
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:HERNANDEZ
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 1:5746 S CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-1022
Mailing Address - Country:US
Mailing Address - Phone:312-216-9285
Mailing Address - Fax:708-425-8273
Practice Address - Street 1:9524 S TRIPP AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3235
Practice Address - Country:US
Practice Address - Phone:773-443-3411
Practice Address - Fax:708-425-8272
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter