Provider Demographics
NPI:1689967291
Name:JENNIFER HEIN, INC
Entity Type:Organization
Organization Name:JENNIFER HEIN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:773-771-4986
Mailing Address - Street 1:915 W MONTANA ST APT 24
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2440
Mailing Address - Country:US
Mailing Address - Phone:773-771-4986
Mailing Address - Fax:
Practice Address - Street 1:1820 W WEBSTER AVE STE 304
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2927
Practice Address - Country:US
Practice Address - Phone:773-771-4986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-005937225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty