Provider Demographics
NPI:1558552356
Name:LLOYD, JENNIFER MARIE (NCTMB,LMT,LST)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:LLOYD
Suffix:
Gender:F
Credentials:NCTMB,LMT,LST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 MARYVILLE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-5119
Mailing Address - Country:US
Mailing Address - Phone:618-931-1000
Mailing Address - Fax:618-931-2737
Practice Address - Street 1:3100 MARYVILLE RD
Practice Address - Street 2:SUITE B
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-5119
Practice Address - Country:US
Practice Address - Phone:618-931-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist