Provider Demographics
NPI:1972775633
Name:KENEBREW, TINA C (DT)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:C
Last Name:KENEBREW
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3142 OLIVE RD
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1416
Mailing Address - Country:US
Mailing Address - Phone:708-785-2992
Mailing Address - Fax:708-799-2882
Practice Address - Street 1:3142 OLIVE RD
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1416
Practice Address - Country:US
Practice Address - Phone:708-785-2992
Practice Address - Fax:708-799-2882
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency