Provider Demographics
NPI:1346890852
Name:CARPENTIER, GENA
Entity Type:Individual
Prefix:
First Name:GENA
Middle Name:
Last Name:CARPENTIER
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 1:6012 EL MORRO LN
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-1806
Mailing Address - Country:US
Mailing Address - Phone:708-646-5599
Mailing Address - Fax:
Practice Address - Street 1:7617 HEMLOCK DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4253
Practice Address - Country:US
Practice Address - Phone:708-646-5599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist