Provider Demographics
NPI:1982091849
Name:GREEN, JENNIFER HANNAH
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HANNAH
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11511 DOUGLAS AVE
Mailing Address - Street 2:APT. 206
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-7187
Mailing Address - Country:US
Mailing Address - Phone:815-321-1490
Mailing Address - Fax:
Practice Address - Street 1:11511 DOUGLAS AVE
Practice Address - Street 2:APT. 206
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-7187
Practice Address - Country:US
Practice Address - Phone:815-321-1490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker