Provider Demographics
NPI:1780084830
Name:MEEHAN, JENNIFER L (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:MEEHAN
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11259 S. HARLEM AVE.
Mailing Address - Street 2:
Mailing Address - City:WORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60482
Mailing Address - Country:US
Mailing Address - Phone:708-361-1400
Mailing Address - Fax:708-361-9490
Practice Address - Street 1:11259 S. HARLEM AVE.
Practice Address - Street 2:
Practice Address - City:WORTH
Practice Address - State:IL
Practice Address - Zip Code:60482
Practice Address - Country:US
Practice Address - Phone:708-361-1400
Practice Address - Fax:708-361-9490
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227013918225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist