Individual
JENNIFER JOANN DIENELT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1799 KINGS GATE LN, CRYSTAL LAKE, IL 60014-2906
(815) 276-7786
(815) 788-1321
Mailing address
PO BOX 377, CRYSTAL LAKE, IL 60039-0377
(815) 276-7786
(815) 788-1321
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
IL
Other
Enumeration date
03/02/2019
Last updated
03/02/2019
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