Provider Demographics
NPI:1508909797
Name:CARBONELL-RODRIGUEZ, JOANNE (DT)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:
Last Name:CARBONELL-RODRIGUEZ
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 1:2800 W JEROME ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1231
Mailing Address - Country:US
Mailing Address - Phone:773-508-0329
Mailing Address - Fax:773-274-8685
Practice Address - Street 1:3040 N WILTON AVE
Practice Address - Street 2:2ND FL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4424
Practice Address - Country:US
Practice Address - Phone:773-296-7687
Practice Address - Fax:773-296-7281
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILJC54880398POtherEARLY INTERVENTION PROVID