Provider Demographics
NPI:1750833042
Name:MOKOS, JENNIFER (BS, EDM, CFCP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:MOKOS
Suffix:
Gender:F
Credentials:BS, EDM, CFCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 LINCOLNSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-5608
Mailing Address - Country:US
Mailing Address - Phone:217-480-7719
Mailing Address - Fax:
Practice Address - Street 1:1010 LINCOLNSHIRE DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-5608
Practice Address - Country:US
Practice Address - Phone:217-480-7719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator