Provider Demographics
NPI:1467255281
Name:HARRIS, JENNIFER ANN
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:HARRIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:FOCHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 722
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:IL
Mailing Address - Zip Code:60927-0722
Mailing Address - Country:US
Mailing Address - Phone:815-549-2072
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 722
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:IL
Practice Address - Zip Code:60927-0722
Practice Address - Country:US
Practice Address - Phone:815-549-2072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist