Provider Demographics
NPI:1245401850
Name:CARRINO, JENNIFER J (BSEDDT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:J
Last Name:CARRINO
Suffix:
Gender:F
Credentials:BSEDDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9344 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-1210
Mailing Address - Country:US
Mailing Address - Phone:630-881-8603
Mailing Address - Fax:708-447-1680
Practice Address - Street 1:9344 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-1210
Practice Address - Country:US
Practice Address - Phone:630-881-8603
Practice Address - Fax:708-447-1680
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-22
Last Update Date:2008-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILJCP48800801P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist