Provider Demographics
NPI:1982815890
Name:HANEY, JENNIFER (DT-HEARING)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HANEY
Suffix:
Gender:F
Credentials:DT-HEARING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N MCCLURG
Mailing Address - Street 2:#3601
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:847-312-0533
Mailing Address - Fax:
Practice Address - Street 1:400 N MCCLURG CT APT 3601
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5530
Practice Address - Country:US
Practice Address - Phone:847-312-0533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILJH58081006P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist