Individual
MS. JEANNE ELLEN BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2640 W 89TH PL, EVERGREEN PARK, IL 60805-1302
(708) 423-2496
Mailing address
2640 W 89TH PL, EVERGREEN PARK, IL 60805-1302
(708) 423-2496
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
227.008830
IL
Other
Enumeration date
11/16/2009
Last updated
11/16/2009
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