Provider Demographics
NPI:1639368327
Name:JENKINS, PATRICIA M
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:M
Last Name:JENKINS
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 1:950 N WESTERN AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1742
Mailing Address - Country:US
Mailing Address - Phone:847-615-2520
Mailing Address - Fax:
Practice Address - Street 1:950 N WESTERN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1742
Practice Address - Country:US
Practice Address - Phone:847-615-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner