Provider Demographics
NPI:1952788986
Name:HARTMANN, JENNIFER (LAC, LMT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HARTMANN
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 S PARK RD
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2540
Mailing Address - Country:US
Mailing Address - Phone:630-935-5450
Mailing Address - Fax:
Practice Address - Street 1:900 CHICAGO AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-1872
Practice Address - Country:US
Practice Address - Phone:630-519-6514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.016997174400000X
IL198.001339171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171100000XOther Service ProvidersAcupuncturist