Provider Demographics
NPI:1639576044
Name:ROSENBERG, JENIFER M (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:JENIFER
Middle Name:M
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7006 W JARVIS AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-4326
Mailing Address - Country:US
Mailing Address - Phone:847-322-1990
Mailing Address - Fax:
Practice Address - Street 1:840 WILLOW RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-6823
Practice Address - Country:US
Practice Address - Phone:847-564-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227008184225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist